The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine

Shapiro, Arie; Zohar, Edna; Zaslansky, Ruth; Hoppenstein, David; Shabat, Shay; Fredman, Brian

doi:10.1016/j.jclinane.2005.01.006

Cited by 139 publications

(83 citation statements)

References 19 publications

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“…Of the 13 patients (1.86%) reported with respiratory depression, 11 had sedation scores of at least 2 and, in contrast to the statements above, all had respiratory rates of <10 breaths/min (Shapiro et al, 2005 Level IV).…”

Section: Respiratory Depressionmentioning

confidence: 80%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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Section: Respiratory Depressionmentioning

confidence: 80%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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“…Concomitant administration of intravenous medications, however, adds some management problems, particularly in older patients, in relation to drug interactions and the effectiveness of the excretory renal and respiratory functions [3,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The first reports were favorable to the administration of morphine with PCA, even if with different doses in relation to age until the individualization of treatment [17]. Unfortunately some clinical observations have highlighted the possibility of side effects from opioid overdose in the postoperative period [15] and also in the administration with PCA [14].…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study

et al. 2014

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The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p \ 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p \ 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score [ 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p \ 0.05).

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“…Other investigators established a direct correlation between intraoperative IV fentanyl and postoperative respiratory depression when epidural opioids were given postoperatively (12).…”

Section: Discussionmentioning

confidence: 99%

The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

Anghelescu

Ross

Oakes

et al. 2008

Journal of Pain and Symptom Management

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Supplementation of epidural opioid analgesia with intravenous opioids is usually avoided because of concern about respiratory depression. However, the choice of adjunct analgesic agents for pediatric oncology patients is limited. Antipyretic drugs may mask fever in neutropenic patients, and nonsteroidal anti-inflammatory agents may exert anti-platelet effects and interact with chemotherapeutic agents. We examined the safety of concurrent use of epidural and intravenous opioids in a consecutive series of 117 epidural infusions in pediatric patients and compared our findings to those reported by other investigators. We observed a 0.85% rate of clinically significant respiratory complications. The single adverse event was associated with an error in dosage. In our experience, the supplementation of epidural opioid analgesia with intravenous opioids has been a safe method of postoperative pain control for pediatric patients with cancer.

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The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine

Cited by 139 publications

References 19 publications

Safety of opioid patch initiation in Australian residential aged care

Safety of opioid patch initiation in Australian residential aged care

Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study

The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

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