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Dose-response relationship between opioid use and adverse effects after ambulatory surgery.
J Pain Symptom Manage. 2004 Jul; 28(1):35-46.JP

Abstract

This health outcomes analysis based on data from a randomized, double-blind, placebo-controlled trial determined dose-response relationship between opioid use and related symptoms. All patients received intravenous fentanyl on demand for pain predischarge, and oral acetaminophen 500 mg/hydrocodone 5 mg every 4-6 hours as needed postdischarge for up to 7 days postsurgery. Patients completed an opioid-related Symptom Distress Scale (SDS) questionnaire every 24 hours postdischarge for 7 days, which assessed 12 opioid-related symptoms by 3 ordinal measures: frequency, severity, and bothersomeness. Clinically meaningful events (CMEs) were defined based on the responses to this questionnaire. Opioid use was converted to morphine equivalent dose (MED). The dose-response relationship between composite SDS scores and MED on Day 1, on Days 0 and 1, and on Days 1-4, was assessed. SDS scores for all 12 symptoms within the 3 dimensions were significantly associated with MED on Day 1 (F-value=1.56; P=0.04), as well as cumulative MED used on Days 0 and 1 (F-value=1.85; P<0.01). Patients with a specific CME used a higher MED than those without a CME on Day 1 (P<0.001). Between Days 1 and 4, patients with a higher number of patient-CME-days used a significantly higher MED. Regression analyses suggested that once the MED reached a threshold, approximately every 4 mg increase in MED was related to 1 additional patient-CME-day (P<0.01). A dose-response relationship empirically exists between MED and directly assessed opioid-related CMEs after ambulatory laparoscopic cholecystectomy. Once daily MED reaches a threshold, every 3-4 mg increase will be associated with 1 additional clinically meaningful opioid-related symptom, or 1 additional patient-day with an opioid-related CME.

Authors+Show Affiliations

Global Health Outcomes Research, Pfizer, Inc., Peapack, New Jersey, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15223083

Citation

Zhao, Sean Z., et al. "Dose-response Relationship Between Opioid Use and Adverse Effects After Ambulatory Surgery." Journal of Pain and Symptom Management, vol. 28, no. 1, 2004, pp. 35-46.
Zhao SZ, Chung F, Hanna DB, et al. Dose-response relationship between opioid use and adverse effects after ambulatory surgery. J Pain Symptom Manage. 2004;28(1):35-46.
Zhao, S. Z., Chung, F., Hanna, D. B., Raymundo, A. L., Cheung, R. Y., & Chen, C. (2004). Dose-response relationship between opioid use and adverse effects after ambulatory surgery. Journal of Pain and Symptom Management, 28(1), 35-46.
Zhao SZ, et al. Dose-response Relationship Between Opioid Use and Adverse Effects After Ambulatory Surgery. J Pain Symptom Manage. 2004;28(1):35-46. PubMed PMID: 15223083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-response relationship between opioid use and adverse effects after ambulatory surgery. AU - Zhao,Sean Z, AU - Chung,Frances, AU - Hanna,David B, AU - Raymundo,Anna L, AU - Cheung,Raymond Y, AU - Chen,Connie, PY - 2003/11/03/accepted PY - 2004/6/30/pubmed PY - 2004/8/20/medline PY - 2004/6/30/entrez SP - 35 EP - 46 JF - Journal of pain and symptom management JO - J Pain Symptom Manage VL - 28 IS - 1 N2 - This health outcomes analysis based on data from a randomized, double-blind, placebo-controlled trial determined dose-response relationship between opioid use and related symptoms. All patients received intravenous fentanyl on demand for pain predischarge, and oral acetaminophen 500 mg/hydrocodone 5 mg every 4-6 hours as needed postdischarge for up to 7 days postsurgery. Patients completed an opioid-related Symptom Distress Scale (SDS) questionnaire every 24 hours postdischarge for 7 days, which assessed 12 opioid-related symptoms by 3 ordinal measures: frequency, severity, and bothersomeness. Clinically meaningful events (CMEs) were defined based on the responses to this questionnaire. Opioid use was converted to morphine equivalent dose (MED). The dose-response relationship between composite SDS scores and MED on Day 1, on Days 0 and 1, and on Days 1-4, was assessed. SDS scores for all 12 symptoms within the 3 dimensions were significantly associated with MED on Day 1 (F-value=1.56; P=0.04), as well as cumulative MED used on Days 0 and 1 (F-value=1.85; P<0.01). Patients with a specific CME used a higher MED than those without a CME on Day 1 (P<0.001). Between Days 1 and 4, patients with a higher number of patient-CME-days used a significantly higher MED. Regression analyses suggested that once the MED reached a threshold, approximately every 4 mg increase in MED was related to 1 additional patient-CME-day (P<0.01). A dose-response relationship empirically exists between MED and directly assessed opioid-related CMEs after ambulatory laparoscopic cholecystectomy. Once daily MED reaches a threshold, every 3-4 mg increase will be associated with 1 additional clinically meaningful opioid-related symptom, or 1 additional patient-day with an opioid-related CME. SN - 0885-3924 UR - https://www.unboundmedicine.com/medline/citation/15223083/Dose_response_relationship_between_opioid_use_and_adverse_effects_after_ambulatory_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885392404001083 DB - PRIME DP - Unbound Medicine ER -