American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Abstract

a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

Low Incidence of Opioid-Induced Respiratory Depression Observed with Oliceridine Regardless of Age or Body Mass Index: Exploratory Analysis from a Phase 3 Open-Label Trial in Postsurgical Pain

“…Benzodiazepines are commonly used preoperatively due to their amnesic and anxiolytic effect [43,44]. Likewise, in the current era of use of multimodal analgesia in ERAS protocols, gabapentinoids are commonly used to reduce postoperative pain and lower opioid consumption [43,45].…”

“…Benzodiazepines are commonly used preoperatively due to their amnesic and anxiolytic effect [43,44]. Likewise, in the current era of use of multimodal analgesia in ERAS protocols, gabapentinoids are commonly used to reduce postoperative pain and lower opioid consumption [43,45]. The concomitant administration of benzodiazepines or gabapentinoids with opioids can have a synergistic effect thereby increasing the risk for OIRD [10,43,46,47].…”

“…There is limited information in the literature regarding the influence of type of surgery on the risk of OIRD, with a recent meta-analysis failing to find an association between type of surgery and risk of OIRD [9]. The revised Guidelines on ''Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression'' issued by the American Society for Pain Management Nursing (ASPMN) identifies the surgical site of head, neck, chest and upper abdomen as a risk factor for OIRD [43]. In our analysis, none of the surgical types was significantly associated with increased risk of OIRD although patients undergoing orthopedic surgery had * 50% lower odds of experiencing OIRD.…”

“…In our analysis, none of the surgical types was significantly associated with increased risk of OIRD although patients undergoing orthopedic surgery had * 50% lower odds of experiencing OIRD. It is possible that the higher utilization of regional anesthesia for orthopedic surgeries could have contributed to these findings [43].…”

Risk factors for severe opioid-induced respiratory depression in hospitalized adults: A case–control study

“…Research efforts are currently devoted to the development of opioids without CNS depressant effects, 33 but until they become routinely prescribed in hospital settings, adequate monitoring following opioid administration remains one of the best currently available strategies for preventing OIRD. 8,34 Limitations The results of this study are based on retrospective data extraction from medical records at the study site, where documentation by exception is the norm. We assumed that the lack of documentation of existing risk factors (e.g., cardiac or renal disease) in any medical file corresponded to the absence of the respective risk factors.…”