The relationship between postoperative opioid consumption and the incidence of hypoxemic events following total hip arthroplasty: a post hoc analysis

Abstract

Background: Postoperative opioid analgesia may cause respiratory depression. We assessed whether following total hip arthroplasty, placebo-adjusted reductions in morphine consumption at 48 hours with parecoxib (47.0%), propacetamol (35.1%) or parecoxib plus propacetamol (67.9%) translated into a reduction in hypoxemic events.Methods: This was a post hoc analysis of a randomized, placebo-controlled, noninferiority study. Patients were randomly assigned to receive intravenous parecoxib (40 mg twice daily), propacetamol (2 g 4 times daily), parecoxib plus propacetamol (40 mg twice daily + 2 g 4 times daily) or placebo. Dose, date and time of morphine administration via patient-controlled analgesia were monitored throughout the study. In patients not receiving supplemental oxygen, peripheral blood oxygenation was assessed continuously for 48 hours after surgery. Hypoxemia was defined as peripheral oxygen saturation less than 90%. The times and oximeter readings of hypoxemic events were recorded. Pearson correlation coefficient was used to assess for correlations between cumulative morphine consumption at 48 hours and mean number of hypoxemic events.Results: A significantly smaller proportion of patients who received the combined treatment with parecoxib and propacetamol had hypoxemia versus placebo (2.8% v. 13.2%, p < 0.05), and the mean number of hypoxemic events was significantly smaller for parecoxib (0.12), propacetamol (0.06) and parecoxib plus propacetamol (0.03) versus placebo (0.36; all p < 0.05). There was no correlation between the reduction in cumulative morphine consumption at 48 hours and the mean number of hypoxemic events in any treatment group (all p > 0.1). Conclusion:Following total hip arthroplasty, a greater than 70% reduction in morphine consumption may be necessary to translate into a corresponding reduction in hypoxemic events.Contexte : L'utilisation d'analgésiques opioïdes en période postopératoire peut provoquer une dépression respiratoire. Nous avons voulu déterminer si, après une arthroplastie totale de la hanche, une réduction de la consommation de morphine à 48 heures par l'administration de parécoxib (47,0 %), de propacétamol (35,1 %) ou d'une combinaison des deux (67,9 %) -avec ajustement selon un groupe placebo -se traduirait par une réduction du nombre d'épisodes d'hypoxémie.Méthodes : Nous avons effectué une analyse post hoc d'une étude randomisée de non-infériorité avec témoins sous placebo. Après une répartition aléatoire, chaque patient a reçu par intraveineuse du parécoxib (40 mg 2 fois par jour), du propacétamol (2 g 4 fois par jour), une combinaison de parécoxib et de propacétamol (40 mg 2 fois par jour + 2 g 4 fois par jour) ou un placebo. Tout au long de l'étude, la dose, la date et le moment de l'administration de morphine contrôlée par le patient ont été notés. Chez les patients qui ne recevaient pas d'oxygène d'appoint, la saturation périphérique en oxygène a été surveillée de manière continue pendant les 48 heures suivant l'opération. L'hypoxémie a été définie comme une ...

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

“…A cohort study conducted by Namba[18] showed use of medium-low (100-219 mg) amounts of oral morphine equivalents in days 91-180 after surgery was associated with a 6 times higher adjusted risk of 1 year revision. Essex et al [19] found that reduction in morphine consumption could reduce the incidence of postoperative hypoxia and asphyxia. Due to the growing problem of opioid abuse, Prentice et al [20] conducted a cohort study to investigate the preoperative risk factors leading to opioid use after total hip arthroplasty, the result showed that the risk factors led to greater utilization in days 91 to 360 including higher body mass index, female sex, acquired immunode ciency syndrome and peripheral vascular disease.…”

Topical use of tranexamic acid can reduce opioid consumption compared with intravenous use for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

“…A cohort study conducted by Namba [ 18 ] showed use of medium–low (100–219 mg) amounts of oral morphine equivalents in days 91–180 after surgery was associated with a 6 times higher adjusted risk of 1 year revision. Essex et al [ 19 ] found that reduction in morphine consumption could reduce the incidence of postoperative hypoxia and asphyxia. Due to the growing problem of opioid abuse, Prentice et al [ 20 ] conducted a cohort study to investigate the preoperative risk factors leading to opioid use after total hip arthroplasty, the result showed that the risk factors led to greater utilization in days 91 to 360 including higher body mass index, female sex, acquired immunodeficiency syndrome and peripheral vascular disease.…”