Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial

R.D. Urman*, A.K. Khanna, S.D. Bergese, W. Buhre, M. Wittmann, M. Le Guen, F.J. Overdyk, F. Di Piazza, L. Saager

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Study objective: Opioid administration for pain in general care floor patients remains common, and can lead to adverse outcomes, including respiratory compromise. The PRODIGY trial found that among ward patients receiving parenteral opioids, 46% experienced >= 1 respiratory depression episode. The objective of this analysis was to evaluate the geographic differences of opioid administration and examine the association between opioid administration characteristics and the occurrence of respiratory depression.Design: Prospective observational trial.Setting: 16 general care medical and surgical wards in Asia, Europe, and the United States.Patients: 1335 patients receiving parenteral opioids.Interventions: Blinded, alarm-silenced continuous capnography and pulse oximetry monitoring.Measurements: Opioid-induced respiratory depression, defined as respiratory rate <= 5 bpm, SpO(2) <= 85%, or ETCO2 <= 15 or >= 60 mmHg for >= 3 min; apnea episode lasting >30 s; or any respiratory opioid-related adverse event.Results: Across all patients, 58% received only long-acting opioids, 16% received only short-acting (<3 h) opioids, and 21% received a combination of short- and long-acting (>= 3 h) opioids. The type and median total morphine milligram equivalent (MME) of opioid administered varied significantly by region, with 31.5 (12.5-76.7) MME, 31.0 (6.2-99.0) MME, and 7.2 (1.7-18.7) MME in the United States, Europe, and Asia, respectively (p < 0.001). Considering only postoperative opioids, 54% (N = 119/220) and 45% (N = 347/779) of patients receiving only short-acting opioids or only long-acting opioids experienced >= 1 episode of opioid-induced respiratory depression, respectively. Multivariable analysis identified post-procedure tramadol (OR 0.62, 95% CI 0.424-0.905, p = 0.0133) and post-procedure epidural opioids (OR 0.485, 95% CI 0.322-0.731, p = 0.0005) being associated with a significant reduction in opioid-induced respiratory depression.Conclusions: Despite varying opioid administration characteristics between Asia, Europe, and the United States, opioid-induced respiratory depression remains a common global problem on general care medical and surgical wards. While the use of post-procedure tramadol or post-procedure epidural opioids may reduce the incidence of respiratory depression, continuous monitoring is also necessary to ensure patient safety when receiving post-operative opioids.
Original languageEnglish
Article number110167
Number of pages8
JournalJournal of Clinical Anesthesia
Volume70
DOIs
Publication statusPublished - 1 Jun 2021

Keywords

  • Continuous monitoring
  • Respiratory depression
  • General care floor
  • Opioid
  • Respiratory compromise
  • SHORT-ACTING OPIOIDS
  • PAIN MANAGEMENT
  • SURGERY
  • ANALGESICS
  • HYPOXEMIA
  • RECOVERY
  • EVENTS
  • ACCESS
  • COST

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