<p>Effect of Fentanyl-Based Intravenous Patient-Controlled Analgesia with and without Basal Infusion on Postoperative Opioid Consumption and Opioid-Related Side Effects: A Retrospective Cohort Study</p>

Abstract

We aimed to investigate the effect of a basal opioid infusion in fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on postoperative opioid consumption, pain intensity, and occurrence of opioid-related side effects. Patients and Methods: We retrospectively reviewed 2097 consecutive patients who received IV-PCA after elective general, thoracic, urologic, and plastic surgery under general anesthesia between June 2019 and October 2019. The patients were divided into two groups: IV-PCA with basal infusion (basal group) and IV-PCA without basal infusion (no basal group). We performed a propensity score matching (PSM) analysis to adjust for baseline differences between both groups. We compared the fentanyl PCA consumption (mcg), pain intensity, rescue analgesic administration, and occurrence of opioid-related side effects (nausea, vomiting, somnolence or dizziness, and overall side effects) during the first 48 hours postoperatively between the two groups before and after PSM. Results: We analyzed 1317 eligible patients. Of these, 757 (57.5%) patients received IV-PCA without basal infusion. The PSM of the total cohort yielded 539 pairs of cases. After PSM, the fentanyl PCA consumption was significantly lower in the no basal group at 48 hours postoperatively as compared to the basal group (at 24 hours, the median difference: −80 mcg, P<0.001, 95% CI=−112-−45 mcg; at 48 hours, the median difference: −286 mcg, P<0.001, 95% CI=−380-−190 mcg), without significantly increasing pain intensity and administration of rescue analgesia. The occurrence of overall opioid-related side effects was also significantly lower in the no basal group (at 24 hours: 31.0% vs 23.0%, OR=0.67, P=0.003, 95% CI=0.51-0.87; at 48 hours: 18.9% vs 11.0%, OR=0.48, P<0.001, 95% CI=0.31-0.75). Conclusion: Basal infusion of fentanyl-based IV-PCA was significantly associated with an increase in fentanyl consumption and the occurrence of opioid-related side effects in postsurgical patients.

Effects of sugammadex versus neostigmine on postoperative nausea and vomiting in adult patients after general anesthesia: A single-center retrospective study

“…We determined that these changes could affect the PONV occurrence rate and decided to include in this study only patients who underwent surgery in 2020. With the PONV occurrence rate of patients who received neostigmine assumed to be 18%, based on our acute pain service team's data (Jung et al 2020), the group sample sizes of 5918 for sugammadex and 4994 for neostigmine could achieve 90% power to reveal a difference in proportion between the groups of -2.3%.…”

A Retrospective Comparative Study of Local Anesthesia Only and Local Anesthesia with Sedation for Percutaneous Endoscopic Lumbar Discectomy

“…Opioids are mainly used to relieve pain by binding to the opioid receptors in the central and peripheral nervous systems 30 . However, it has several side effects, including nausea, vomiting, dizziness, itching, sedation, respiratory depression, uroschesis, constipation, euphoria, nausea, vomiting, respiratory depression, excessive sedation, and liver dysfunction [31][32][33][34][35][36] . Meanwhile, NSAIDs are predominantly applied to inhibit the synthesis of prostaglandins and the release of bradykinin in the process of in ammation to achieve pain relief 37,38 .…”

Effect of postoperative non-steroidal anti-inflammatory drugs on anastomotic leakage after pancreaticoduodenectomy

“…have used the IV-PCA comprising only fentanyl, and in July 2019, we introduced the IV-PCA without basal infusion [15]. Ketorolac has been administered as an intravenous rescue analgesic based on the attending surgeon's preference, and ibuprofen has also been administered as an oral rescue analgesic after the resumption of oral intake.…”

“…By March 2019, IV-PCA comprised a mixture of fentanyl and morphine in a bolus of 1 ml (intravenous morphine equivalent dose [IVMED] 1–2.5 mg) with a lockout interval of 15 min and a basal infusion rate of 1 ml/h (IVMED 1–2.5 mg/h). Since April 2019, we have used the IV-PCA comprising only fentanyl, and in July 2019, we introduced the IV-PCA without basal infusion [ 15 ]. Ketorolac has been administered as an intravenous rescue analgesic based on the attending surgeon’s preference, and ibuprofen has also been administered as an oral rescue analgesic after the resumption of oral intake.…”