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Clinical and Economic Burden of Opioid Use for Postsurgical Pain: Focus on Ventilatory Impairment and Ileus
Author(s) -
Barletta Jeffrey F.
Publication year - 2012
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.2012.01178.x
Subject(s) - medicine , ileus , opioid , incidence (geometry) , anesthesia , hydromorphone , intensive care medicine , adverse effect , depression (economics) , apnea , remifentanil , surgery , physics , receptor , optics , economics , macroeconomics , propofol
Opioid‐related adverse drug events ( ORADE s) can have a significant impact on patient recovery after surgery. This review investigates the impact of two ORADE s, respiratory depression and postoperative ileus ( POI ), on clinical and economic outcomes. Opioid‐induced ventilatory impairment is a potentially serious ORADE that can result in apnea and even death. The incidence of ventilatory impairment is approximately 1%, even among patients receiving opioids using patient‐controlled analgesia. Costs are increased in patients treated with opioids who are at high risk of ventilatory impairment due to the need for more intensive monitoring from nursing staff and the use of alarmed monitoring equipment. Opioids, together with other factors, contribute to the development of POI through a direct effect on gut motility. Postoperative ileus has been shown to significantly increase hospital length of stay and cost of care. A key determinant of ileus development, as well as length of stay and costs, is postsurgical opioid dose. Data from a retrospective analysis show that a daily hydromorphone dose of 2 mg/day markedly increases the risk of POI . In addition, although the incidence of POI is reduced in patients who undergo laparoscopic surgery or hand‐assisted laparoscopic surgery compared with open surgery, the reduction of POI can potentially be negated by excessive opioid use. Therefore, multimodal, opioid‐sparing strategies should be explored and used to reduce severe ORADE s and improve outcomes in the surgical setting.