Incidence of Delirium Among Patients Having Cancer Injected With Different Opioids for the First Time

Tanaka, R.; Ishikawa, Hiroshi; Sato, Tetsu; Shino, Michihiro; Matsumoto, Teruaki; Mori, Keita; Omae, Katsuhiro; Osaka, Iwao

doi:10.1177/1049909116641274

Cited by 13 publications

(6 citation statements)

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“…This is consistent with our previous finding 8 that intravenous morphine and oxycodone cause delirium at comparable rates when used as the first opioid. However, we did find that incidence of delirium was lower with the oral formulation than with the intravenous formulation for both morphine and oxycodone (morphine PO in this study vs IV in previous study = 4.8% vs 28.9%, oxycodone PO in this study vs IV in previous study = 6.9% vs 19.5%).…”

Section: Discussionsupporting

confidence: 93%

“…In 2017, we investigated the incidence of delirium in patients receiving intravenous opioids for cancer pain and found that the incidence was significantly lower with intravenous fentanyl citrate compared with intravenous morphine hydrochloride. 8 In addition, Morita et al 3 found that opioid rotation to fentanyl significantly reduced the severity of delirium in cancer patients with morphine-induced delirium.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Delirium With Different Oral Opioids in Previously Opioid-Naive Patients

Sugiyama

Tanaka

Sato

et al. 2022

Am J Hosp Palliat Care

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Background: Opioids are known to induce delirium, but few studies have closely investigated differences in incidence of delirium among different opioids. Objectives: To determine whether there is a clinically significant difference in the incidence of delirium between oral opioids in previously opioid-naive patients. Methods: Subjects were 259 opioid-naive in-patients with cancer who were started on morphine sulfate, oxycodone hydrochloride, or tapentadol hydrochloride extended-release tablets at our hospital between August 1, 2014, and September 30, 2018. The incidence of delirium during the first week of treatment was compared between the drugs. Results: The incidence of delirium was 4.8% (n = 83) for morphine sulfate, 6.9% (n = 131) for oxycodone hydrochloride, and 6.7% (n = 45) for tapentadol hydrochloride. The incidence did not significantly differ between oxycodone hydrochloride (OR = .69, 95% CI = .20–2.30, P [Fisher’s exact test] = .77) or tapentadol hydrochloride (OR = .71, 95% CI = .15–3.32, P [Fisher’s exact test] = .70) and morphine sulfate (reference group). Moreover, the incidence did not significantly differ between tapentadol hydrochloride (OR = 1.03, 95% CI = .27–3.00, P [Fisher’s exact test] = 1.00) and oxycodone hydrochloride (reference group). Conclusion: The incidence of delirium in previously opioid-naive patients did not differ significantly among morphine sulfate, oxycodone hydrochloride, and tapentadol hydrochloride extended-release tablets, suggesting similar risk of delirium in opioid-naive patients among these oral opioids.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Incidence of Delirium With Different Oral Opioids in Previously Opioid-Naive Patients

Sugiyama

Tanaka

Sato

et al. 2022

Am J Hosp Palliat Care

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“…[21][22][23][24][25] Paradoxically, exposure to opioids in hospitalized or cancer patients was significantly associated with an increased risk of delirium. [26][27][28][29] However, Nandi et al 30 found that opioids did not increase the risk of delirium in total joint arthroplasty. Another study performed in a surgical context reported that tramadol and meperidine were associated with an increased risk of delirium but use of morphine, fentanyl, oxycodone, and codeine were not.…”

mentioning

confidence: 99%

Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients

Daoust

Paquet

Boucher

et al. 2020

Academic Emergency Medicine

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Objectives Emergency department (ED) stay and its associated conditions (immobility, inadequate hydration and nutrition, lack of stimulation) increase the risk of delirium in older patients. Poorly controlled pain and paradoxically opioid pain treatment have also been identified as triggers for delirium. The aim of this study was to assess the relationship between pain, opioid treatment, and delirium in older ED patients. Methods A multicenter prospective cohort study was conducted in four hospitals across the province of Québec (Canada). Patients aged ≥ 65 years old, waiting for hospital admission between March and July 2015, who were nondelirious upon ED arrival, who were independent or semi‐independent in their daily living activities, and who had an ED stay of at least 8 hours were included. Delirium assessments were conducted twice a day during the patient’s entire ED stay and their first 24 hours on the hospital ward using the Confusion Assessment Method. Pain intensity was evaluated using a visual analog scale (VAS = 0–100) during the initial interview, and all opioid treatments were documented. Results A total of 338 patients were included; 51% were female, and mean (±SD) age was 77 (±8) years. Forty‐one patients (12%) experienced delirium during their hospital stay occurring within a mean (±SD) delay of 47 (±19) hours after ED admission. Among patients with pain intensity ≥ 65 from VAS (0–100), 26% experienced delirium compared to 11% for patients with pain < 65 (p < 0.01), and no significant association was found between opioid consumption and delirium (p = 0.31). Logistic regression controlling for confounding factors showed that patients with pain intensity ≥ 65 are 3.3 (95% confidence interval = 1.4 to 7.9) times more likely to develop delirium than patients who had pain intensity of <65. Conclusions Severe pain, not opioids, is associated with the development of delirium during ED stay. Adequate pain control during the hospital stay may contribute to a decrease in delirium episodes.

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“…In this study, 40% of opioid-using patients received fentanyl. Tanaka et al compared the incidence of delirium among patients using various opioids [17].…”

Section: Discussionmentioning

confidence: 99%

Effects of opioids, steroids, benzodiazepines, anticholinergics, and antihistamines on the efficacy of antipsychotics for treating delirium in patients undergoing palliative care

Sato

Tanaka

2022

Preprint

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Purpose To investigate the effects of opioid, steroid, benzodiazepine, anticholinergic, and antihistamine combinations on the efficacy of antipsychotics used to treat delirium. Methods End-of-life palliative care patients with overactive delirium were included. Changes in delirium symptoms were assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Changes in scores before and after antipsychotic use in 97 patients with ICDSC scores of ≥ 4 were retrospectively reviewed from medical records. A mean ICDSC score < 4 for the first 3 days after antipsychotic administration was evaluated as effective. The number of days with a score < 4 during the 3 days was also evaluated as a secondary outcome. The two efficacies were compared with and without opioids, steroids, benzodiazepines, anticholinergics, and concomitant antihistamines. Results The concomitant use of benzodiazepines before and after delirium treatment tended to decrease the efficacy rate of antipsychotics (odds ratio, 0.330; 95% CI: 0.089–1.222; p = 0.097). The concomitant use of benzodiazepines also showed a trend toward a lower number of days (%) with a score < 4 (13% vs. 24%, p = 0.061). There was no influence of the concomitant use of opioids, steroids, anticholinergics, or antihistamines observed. Conclusion There may be a few disadvantages to the continued use of opioids, steroids, anticholinergics, and antihistamines after commencing delirium treatment with antipsychotics. However, the continuation of benzodiazepine administration after delirium onset should be carefully considered because of their potential negative influence on the efficacy of delirium treatment.

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Incidence of Delirium Among Patients Having Cancer Injected With Different Opioids for the First Time

Abstract: The incidence of delirium after the commencement of fentanyl injection was significantly lower, suggesting that fentanyl is a useful opioid injection drug from the perspective of delirium risk.

Cited by 13 publications

References 14 publications

Incidence of Delirium With Different Oral Opioids in Previously Opioid-Naive Patients

Incidence of Delirium With Different Oral Opioids in Previously Opioid-Naive Patients

Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients

Effects of opioids, steroids, benzodiazepines, anticholinergics, and antihistamines on the efficacy of antipsychotics for treating delirium in patients undergoing palliative care

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