Adverse events associated with postoperative opioid analgesia: A systematic review

Wheeler, Michelle; Oderda, Gary M.; Ashburn, Michael A.; Lipman, Arthur G.

doi:10.1054/jpai.2002.123652

Cited by 433 publications

(335 citation statements)

References 62 publications

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“…Neuraxial opioids provide superior analgesia compared with systemic opioids, but may also be associated with potentiation of the previously mentioned adverse effects [37], as has been our experience. The onset and duration is determined by lipophilicity of the drug [11].…”

Section: Single Dose Spinal and Epidural Opioidsmentioning

confidence: 51%

“…It takes advantage of the additive or synergistic effects of various analgesics, permitting the use of smaller doses with a concomitant reduction in side effects. Because many of the negative effects of analgesic therapy are related to parenteral opioids [37], limiting its use is a major principle of multimodal analgesia.…”

Section: Our Experience With Multimodal Pain Protocolsmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Maheshwari

Blum

Shekhar

et al. 2009

Clin Orthop Relat Res

287

160

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Improvements in pain management techniques in the last decade have had a major impact on the practice of total hip and knee arthroplasty (THA and TKA). Although there are a number of treatment options for postoperative pain, a gold standard has not been established. However, there appears to be a shift towards multimodal approaches using regional anesthesia to minimize narcotic consumption and to avoid narcotic-related side effects. Over the last 10 years, we have used intravenous patient-controlled analgesia (PCA), femoral nerve block (FNB), and continuous epidural infusions for 24 and 48 hours with and without FNB. Unfortunately, all of these techniques had shortcomings, not the least of which was suboptimal pain control and unwanted side effects. Our practice has currently evolved to using a multimodal protocol that emphasizes local periarticular injections while minimizing the use of parenteral narcotics. Multimodal protocols after THA and TKA have been a substantial advance; they provide better pain control and patient satisfaction, lower overall narcotic consumption, reduce hospital stay, and improve function while minimizing complications. Although no pain protocol is ideal, it is clear that patients should have optimum pain control after TKA and THA for enhanced satisfaction and function. Level of Evidence: Level V, expert opinion. See the Guidelines for Authors for a complete description of levels of evidence.

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Section: Single Dose Spinal and Epidural Opioidsmentioning

confidence: 51%

Section: Our Experience With Multimodal Pain Protocolsmentioning

confidence: 99%

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Maheshwari

Blum

Shekhar

et al. 2009

Clin Orthop Relat Res

287

160

View full text Add to dashboard Cite

show abstract

“…Pero a pesar de los grandes avances en estos nuevos sistemas de infusión IV, los principales efectos secundarios derivados de los opioides siguen limitando su uso 76 .…”

Section: Opioides Y Derivadosunclassified

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Morales-Muñoz

Sánchez-Ramos

Díaz-Lara

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…6,7 Wheeler et al (2002) found that 29.0% of preventable adverse drug events (ADEs) were associated with analgesic use, the majority of which included opioids. 8 The most common of these ORADEs include gastrointestinal (GI) effects such as constipation, ileus, nausea, and vomiting; central nervous system effects including sedation, euphoria, and delirium; pruritus; urinary retention; and more serious adverse effects such as respiratory depression. [8][9][10] Several patient clinical and demographic characteristics have been demonstrated to play a role in increased ORADE risk.…”

mentioning

confidence: 99%

“…8 The most common of these ORADEs include gastrointestinal (GI) effects such as constipation, ileus, nausea, and vomiting; central nervous system effects including sedation, euphoria, and delirium; pruritus; urinary retention; and more serious adverse effects such as respiratory depression. [8][9][10] Several patient clinical and demographic characteristics have been demonstrated to play a role in increased ORADE risk. Perioperative and intraoperative treatment factors associated with ADE incidence include specific procedure type, longer duration of surgery, use of volatile intraoperative anesthetics, general versus regional anesthesia, and postoperative opioid dose and route of administration.…”

mentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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Adverse events associated with postoperative opioid analgesia: A systematic review

Cited by 433 publications

References 62 publications

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Multimodal Pain Management after Total Hip and Knee Arthroplasty at the Ranawat Orthopaedic Center

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

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