La influencia de las dosis de opioides por via intravenosa sobre la oclusión intestinal postoperatoria

Translated title of the contribution: Influence of intravenous opioid dose on postoperative ileus

Jeffrey F. Barletta, Theodor Asgeirsson, Anthony J. Senagore

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

BACKGROUND: Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown. OBJECTIVE: To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI. METHODS: Consecutive patients admitted to a community teaching hospital who underwent elective colorectal surgery by any technique with an enhanced-recovery protocol postoperatively were retrospectively identified. Patients were excluded if they received epidural analgesia, developed a major intraabdominal complication or medical complication, or had a prolonged workup prior to surgery. Intravenous opioid doses were quantified and converted to hydromorphone equivalents. Classification and regression tree (CART) analysis was used to determine the dosing threshold for the opioid measure most associated with POI and define high versus low use of opioids. Risk factors for POI and prolonged LOS were determined through multivariate analysis. RESULTS: The incidence of POI in 279 patients was 8.6%. CART analysis identified a maximum daily intravenous hydromorphone dose of 2 mg or more as the opioid measure most associated with POI. Multivariate analysis revealed maximum daily hydromorphone dose of 2 mg or more (p = 0.034), open surgical technique (p = 0.045), and days of intravenous narcotic therapy (p = 0.003) as significant risk factors for POI. Variables associated with increased LOS were POI (p <0.001), maximum daily hydromorphone dose of 2 mg or more (p <0.001), and age (p = 0.005); laparoscopy (p <0.001) was associated with a decreased LOS. CONCLUSIONS: Intravenous opioid therapy is significantly associated with POI and prolonged LOS, particularly when the maximum hydromorphone dose per day exceeds 2 mg. Clinicians should consider alternative, nonopioid-based pain management options when this occurs.

Original languageSpanish
Pages (from-to)916-923
Number of pages8
JournalAnnals of Pharmacotherapy
Volume45
Issue number7-8
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Ileus
Opioid Analgesics
Hydromorphone
Length of Stay
Multivariate Analysis
Regression Analysis
Colorectal Surgery
Epidural Analgesia
Narcotics
Community Hospital
Pain Management
Teaching Hospitals
Laparoscopy

Keywords

  • Colorectal
  • Dosing
  • Ileus
  • Opioid

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

La influencia de las dosis de opioides por via intravenosa sobre la oclusión intestinal postoperatoria. / Barletta, Jeffrey F.; Asgeirsson, Theodor; Senagore, Anthony J.

In: Annals of Pharmacotherapy, Vol. 45, No. 7-8, 07.2011, p. 916-923.

Research output: Contribution to journalArticle

Barletta, Jeffrey F. ; Asgeirsson, Theodor ; Senagore, Anthony J. / La influencia de las dosis de opioides por via intravenosa sobre la oclusión intestinal postoperatoria. In: Annals of Pharmacotherapy. 2011 ; Vol. 45, No. 7-8. pp. 916-923.
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abstract = "BACKGROUND: Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown. OBJECTIVE: To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI. METHODS: Consecutive patients admitted to a community teaching hospital who underwent elective colorectal surgery by any technique with an enhanced-recovery protocol postoperatively were retrospectively identified. Patients were excluded if they received epidural analgesia, developed a major intraabdominal complication or medical complication, or had a prolonged workup prior to surgery. Intravenous opioid doses were quantified and converted to hydromorphone equivalents. Classification and regression tree (CART) analysis was used to determine the dosing threshold for the opioid measure most associated with POI and define high versus low use of opioids. Risk factors for POI and prolonged LOS were determined through multivariate analysis. RESULTS: The incidence of POI in 279 patients was 8.6{\%}. CART analysis identified a maximum daily intravenous hydromorphone dose of 2 mg or more as the opioid measure most associated with POI. Multivariate analysis revealed maximum daily hydromorphone dose of 2 mg or more (p = 0.034), open surgical technique (p = 0.045), and days of intravenous narcotic therapy (p = 0.003) as significant risk factors for POI. Variables associated with increased LOS were POI (p <0.001), maximum daily hydromorphone dose of 2 mg or more (p <0.001), and age (p = 0.005); laparoscopy (p <0.001) was associated with a decreased LOS. CONCLUSIONS: Intravenous opioid therapy is significantly associated with POI and prolonged LOS, particularly when the maximum hydromorphone dose per day exceeds 2 mg. Clinicians should consider alternative, nonopioid-based pain management options when this occurs.",
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AB - BACKGROUND: Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown. OBJECTIVE: To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI. METHODS: Consecutive patients admitted to a community teaching hospital who underwent elective colorectal surgery by any technique with an enhanced-recovery protocol postoperatively were retrospectively identified. Patients were excluded if they received epidural analgesia, developed a major intraabdominal complication or medical complication, or had a prolonged workup prior to surgery. Intravenous opioid doses were quantified and converted to hydromorphone equivalents. Classification and regression tree (CART) analysis was used to determine the dosing threshold for the opioid measure most associated with POI and define high versus low use of opioids. Risk factors for POI and prolonged LOS were determined through multivariate analysis. RESULTS: The incidence of POI in 279 patients was 8.6%. CART analysis identified a maximum daily intravenous hydromorphone dose of 2 mg or more as the opioid measure most associated with POI. Multivariate analysis revealed maximum daily hydromorphone dose of 2 mg or more (p = 0.034), open surgical technique (p = 0.045), and days of intravenous narcotic therapy (p = 0.003) as significant risk factors for POI. Variables associated with increased LOS were POI (p <0.001), maximum daily hydromorphone dose of 2 mg or more (p <0.001), and age (p = 0.005); laparoscopy (p <0.001) was associated with a decreased LOS. CONCLUSIONS: Intravenous opioid therapy is significantly associated with POI and prolonged LOS, particularly when the maximum hydromorphone dose per day exceeds 2 mg. Clinicians should consider alternative, nonopioid-based pain management options when this occurs.

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