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Influence of intravenous opioid dose on postoperative ileus.
Ann Pharmacother 2011; 45(7-8):916-23AP

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.

Authors+Show Affiliations

Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA. jbarle@midwestern.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21730280

Citation

Barletta, Jeffrey F., et al. "Influence of Intravenous Opioid Dose On Postoperative Ileus." The Annals of Pharmacotherapy, vol. 45, no. 7-8, 2011, pp. 916-23.
Barletta JF, Asgeirsson T, Senagore AJ. Influence of intravenous opioid dose on postoperative ileus. Ann Pharmacother. 2011;45(7-8):916-23.
Barletta, J. F., Asgeirsson, T., & Senagore, A. J. (2011). Influence of intravenous opioid dose on postoperative ileus. The Annals of Pharmacotherapy, 45(7-8), pp. 916-23. doi:10.1345/aph.1Q041.
Barletta JF, Asgeirsson T, Senagore AJ. Influence of Intravenous Opioid Dose On Postoperative Ileus. Ann Pharmacother. 2011;45(7-8):916-23. PubMed PMID: 21730280.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of intravenous opioid dose on postoperative ileus. AU - Barletta,Jeffrey F, AU - Asgeirsson,Theodor, AU - Senagore,Anthony J, Y1 - 2011/07/05/ PY - 2011/7/7/entrez PY - 2011/7/7/pubmed PY - 2011/12/13/medline SP - 916 EP - 23 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 45 IS - 7-8 N2 - 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. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/21730280/Influence_of_intravenous_opioid_dose_on_postoperative_ileus_ L2 - http://journals.sagepub.com/doi/full/10.1345/aph.1Q041?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -