Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial.

Abstract

STUDY OBJECTIVE\nOpioid administration for pain in general care floor patients remains common, and can lead to adverse outcomes, including respiratory compromise. The PRODIGY trial found that among ward patients receiving parenteral opioids, 46% experienced ≥1 respiratory depression episode. The objective of this analysis was to evaluate the geographic differences of opioid administration and examine the association between opioid administration characteristics and the occurrence of respiratory depression.\n\n\nDESIGN\nProspective observational trial.\n\n\nSETTING\n16 general care medical and surgical wards in Asia, Europe, and the United States.\n\n\nPATIENTS\n1335 patients receiving parenteral opioids.\n\n\nINTERVENTIONS\nBlinded, alarm-silenced continuous capnography and pulse oximetry monitoring.\n\n\nMEASUREMENTS\nOpioid-induced respiratory depression, defined as respiratory rate\xa0≤\xa05\xa0bpm, SpO2\xa0≤\xa085%, or ETCO2\xa0≤\xa015 or\xa0≥\xa060\xa0mmHg for ≥3\xa0min; apnea episode lasting >30\xa0s; or any respiratory opioid-related adverse event.\n\n\nRESULTS\nAcross all patients, 58% received only long-acting opioids, 16% received only short-acting (<3\xa0h) opioids, and 21% received a combination of short- and long-acting (≥3\xa0h) opioids. The type and median total morphine milligram equivalent (MME) of opioid administered varied significantly by region, with 31.5 (12.5-76.7) MME, 31.0 (6.2-99.0) MME, and 7.2 (1.7-18.7) MME in the United States, Europe, and Asia, respectively (p\xa0<\xa00.001). Considering only postoperative opioids, 54% (N\xa0=\xa0119/220) and 45% (N\xa0=\xa0347/779) of patients receiving only short-acting opioids or only long-acting opioids experienced ≥1 episode of opioid-induced respiratory depression, respectively. Multivariable analysis identified post-procedure tramadol (OR 0.62, 95% CI 0.424-0.905, p\xa0=\xa00.0133) and post-procedure epidural opioids (OR 0.485, 95% CI 0.322-0.731, p\xa0=\xa00.0005) being associated with a significant reduction in opioid-induced respiratory depression.\n\n\nCONCLUSIONS\nDespite varying opioid administration characteristics between Asia, Europe, and the United States, opioid-induced respiratory depression remains a common global problem on general care medical and surgical wards. While the use of post-procedure tramadol or post-procedure epidural opioids may reduce the incidence of respiratory depression, continuous monitoring is also necessary to ensure patient safety when receiving postoperative opioids. REGISTRATION NUMBER: www.clinicaltrials.gov, ID: NCT02811302.