The Comparative Risk of Delirium with Different Opioids: A Systematic Review

Abstract

ObjectiveThere is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients.MethodsWe performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute.ResultsSix studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small.ConclusionSome data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s40266-017-0455-9) contains supplementary material, which is available to authorized users.

CSF Beta-amyloid 1–42 Concentration Predicts Delirium Following Elective Arthroplasty Surgery in an Observational Cohort Study

“…All participants in this study received intrathecal diamorphine. The independent association between additional intraoperative intravenous opioid administration and postoperative delirium is in keeping with broader published evidence associating opioids and delirium in hospitalised patients (44) however studies examining intraoperative intravenous opioids are limited (45). The numbers of participants receiving fentanyl in our study are too small to challenge recent findings suggesting it is a safer opioid however the relatively high numbers receiving alfentanil, and the limited evidence base available assessing delirium risk in elderly elective surgical populations require further study.…”

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

“…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. 31 Two studies implemented in the surgical field simultaneously examined the relationship between pain, opioids, and delirium. 32,33 The first study, performed on patients with hip fractures, suggested that untreated pain and opioid underuse were important contributors to the development of delirium.…”