Opioid-related adverse drug events in surgical patients: risk factors and association with clinical outcomes

Yiu, Chin Hang; Gnjidic, Danijela; Patanwala, Asad E.; Fong, Ian; Begley, David; Khor, Kok Eng; Rimington, Joanne; Bugeja, Bernadette; Penm, Jonathan

doi:10.1080/14740338.2022.2049230

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…Previous research has shown that suboptimal opioid administration results in adverse effects and/or inadequate pain relief, prolongs the PACU stay, and reduces organizational efficacy. 3,4,6,8 It remains unclear how these elements interact and how this affect patients.…”

Section: Discussionmentioning

confidence: 99%

“…3 In the postoperative setting, pain severity and incidence of ORADEs impact quality of recovery, long-term health, and organizational efficacy. [4][5][6] This calls for an examination of opioid treatment efficacy and an effort to design composite clinical decision-making tools that address both the adequacy of analgesia and incidence of ORADEs. The relationship between these remains underexplored in the literature, [7][8][9] and former attempts to create compound outcomes have not been implemented in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

“…However, this is accompanied by an increased risk of opioid‐related adverse drug events (ORADEs), ranging from mild nausea to life‐threatening respiration depression 3 . In the postoperative setting, pain severity and incidence of ORADEs impact quality of recovery, long‐term health, and organizational efficacy 4–6 . This calls for an examination of opioid treatment efficacy and an effort to design composite clinical decision‐making tools that address both the adequacy of analgesia and incidence of ORADEs.…”

Section: Introductionmentioning

confidence: 99%

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The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality—A protocol for an observational pilot study

Karlsen,

Tran,

Mathiesen

et al. 2024

Acta Anaesthesiol Scand

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BackgroundManaging postoperative pain while minimizing opioid‐related adverse drug events (ORADEs) remains a significant challenge. The OPI•AID Zone Tool is proposed as a novel clinical decision support tool that ‐ both graphically and in a scoring‐system ‐ represents the relationship between pain management and the occurrence of ORADEs, aiming to enhance patient outcomes in postoperative care. The OPI•AID Zone Tool places pain score on the x‐axis and an ORADE score on the y‐axis, and stratifies patients into five zones to reflect the composite impact of pain severity and ORADEs on the quality of postoperative patient care. The study will have two key aims: (1) to explore whether the OPI•AID Zone Tool can function as a composite outcome measure for postoperative pain and ORADEs, and (2) to evaluate the use of the OPI•AID Zone Tool in visual presentations and for evaluation of patients’ postoperative pain management quality.MethodsThis prospective observational cohort study will include 200 adults undergoing various surgical procedures in general anesthesia with a subsequent stay in the post‐anesthesia care unit (PACU) at Bispebjerg Hospital, Denmark.Substudy 1 primary outcome: To assess whether a zone score in the OPI•AID Zone Tool is associated with patient‐perceived health (EQ VAS), quality of recovery (QoR‐PACU), and time to discharge readiness in PACU, and if the zone score has a stronger association than pain and ORADE score in themselves.Substudy 2 primary outcome: To assess how the use of intraoperative non‐opioid analgesics impact where patients are placed in the OPI•AID Zone Tool's XY scatterplot right after surgery.To assess if patients who receive more comprehensive non‐opioid analgesic basic regimens, generally fall into lower zones.ConclusionThe OPI•AID Zone Tool could potentially be a valuable clinical decision‐making tool for optimizing postoperative care by simultaneously addressing pain management and the risk of ORADEs. By computing a composite measure of these two critical outcomes, the tool could guide more nuanced and patient‐centered analgesic regimens, potentially improving patient satisfaction and operational efficiency in postoperative settings. The tool's applicability will be explored in this observational pilot and followed up in a planned series of studies (opiaid.dk).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality—A protocol for an observational pilot study

Karlsen,

Tran,

Mathiesen

et al. 2024

Acta Anaesthesiol Scand

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“…Although OIH does not occur as frequently as other adverse reactions associated with opioids, it leads to decreased patient satisfaction. In addition, the incidence of adverse reactions is higher following the addition of opiates, up to 6.2-10.2% ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of flurbiprofen‑axetil combined with nalbuphine pretreatment on remifentanil‑induced postoperative hyperalgesia: A randomized clinical trial

Zhao,

Mu,

Zhang

et al. 2023

Exp Ther Med

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Remifentanil-induced hyperalgesia (RIH) is a common and complicated issue in patients undergoing laparoscopic cholecystectomy (LC), which significantly reduces patient satisfaction. The present trial was designed to clarify the individual and combined effects of flurbiprofen-axetil and nalbuphine on remifentanil-induced hyperalgesia. This randomized double-blind clinical trial included 120 adult patients who underwent LC at The Second People's Hospital of Wuhu. The individuals were randomized into a flurbiprofen-axetil group (F group), nalbuphine group (N group), flurbiprofen-axetil combined with nalbuphine group (FN group) and saline group (S group). The four groups were given flurbiprofen-axetil (50 mg, iv.), nalbuphine (0.1 mg/kg, iv.), flurbiprofen-axetil (50 mg, iv.) combined with nalbuphine (0.1 mg/kg, iv.) or normal saline respectively prior to skin incision. The primary outcome was the postoperative mechanical pain thresholds at the inner forearm and peri-incisional area. The secondary outcomes were the visual analog scale (VAS) and Ramsay sedation scale at 0.5, 1, 4 and 24 h after surgery, and any other adverse events. The pain threshold of the medial forearm in the FN group did not differ from that in the F and N groups at 24 h after surgery (P=0.310 and P=0.910, respectively). However, the pain threshold around the incision in FN group was significantly lower than that in F and N groups 24 h after surgery (P=0.001). The VAS of the F group, N group and FN group were all significantly lower than that in the S group at 0.5, 1 and 24 h after surgery (P<0.001). No significant differences were observed in the incidence of adverse events between the four groups. Single flurbiprofen-axetil and single nalbuphine effectively prevented RIH 24 h after surgery in LC. The combination of the two analgesic drugs, with different mechanisms of action, was not superior to single therapy. The present study was registered with the Chinese Clinical Trial Registry (registration no. ChiCTR2100045347).

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Tapentadol Versus Oxycodone for Opioid-Related Adverse Drug Events and Clinical Outcomes After Inpatient Surgery

Liu,

Patanwala,

Naylor

et al. 2024

The Journal of Pain

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Opioid-related adverse drug events in surgical patients: risk factors and association with clinical outcomes

Cited by 3 publications

References 28 publications

The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality—A protocol for an observational pilot study

The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality—A protocol for an observational pilot study

Efficacy and safety of flurbiprofen‑axetil combined with nalbuphine pretreatment on remifentanil‑induced postoperative hyperalgesia: A randomized clinical trial

Tapentadol Versus Oxycodone for Opioid-Related Adverse Drug Events and Clinical Outcomes After Inpatient Surgery

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