Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Participants
2.2. Data Collection
2.3. Exposure
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Baseline Patient Characteristics and Operative Variables
3.2. Relationship between Intravenous Patient-Controlled Analgesia Use and Outcomes
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Patients (n = 816) | Without ivPCA (n = 238) | With ivPCA (n = 578) | p Value | |
---|---|---|---|---|
Age (years) | 45 (36–56) | 40 (32–52) | 46 (38–58) | <0.001 |
Height (cm) | 158 (154–162) | 158 (154–162) | 158.2 (155–162) | 0.747 |
Weight (kg) | 53.3 (48.4–59.9) | 52.4 (48.1–57.9) | 54.0 (48.4–60.7) | 0.020 |
Never smoker | 621 (76.1%) | 186 (78.2%) | 435 (75.3%) | 0.379 |
ASA-PS (1/2/3/missing) | 437/360/14/5 | 132/100/3/3 | 305/260/11/2 | <0.001 |
Malignancy | 223 (27.3%) | 38 (16.0%) | 185 (32.0%) | <0.001 |
Emergency surgery | 45 (5.5%) | 35 (14.7%) | 10 (1.7%) | <0.001 |
Duration of surgery (min) | 183 (124–266) | 129 (86–186) | 212 (148–310) | <0.001 |
Intraoperative blood loss (mL) | 10 (0–100) | 0 (0–50) | 25 (0–110) | <0.001 |
Total intraoperative fentanyl dose (μg) | 200 (150–250) | 150 (100–250) | 250 (150–300) | <0.001 |
Intraoperative antiemetic use | 318 (39.0%) | 57 (23.9%) | 261 (45.2%) | <0.001 |
Total intravenous anesthesia | 144 (17.6%) | 50 (21.0%) | 94 (16.3%) | 0.106 |
Variable | Adjusted OR (95% CI) | p Value |
---|---|---|
ivPCA | 1.80 (1.24–2.61) | 0.002 |
Age (per 10 years) | 1.06 (0.95–1.19) | 0.295 |
Malignancy | 0.86 (0.56–1.14) | 0.474 |
Duration of surgery (per hour) | 1.13 (1.03–1.25) | 0.010 |
Intraoperative blood loss (per mL) | 0.99 (0.99–1.00) | 0.861 |
Total intraoperative fentanyl dose (per μg) | 0.99 (0.99–1.00) | 0.429 |
Ever smoker | 0.81 (0.57–1.14) | 0.222 |
Intraoperative antiemetic use | 0.96 (0.70–1.31) | 0.800 |
Total intravenous anesthesia | 0.81 (0.54–1.23) | 0.328 |
Event Count | Adjusted OR (95% CI) | p Value | ||
---|---|---|---|---|
With ivPCA (n = 578) | Without ivPCA (n = 238) | |||
Postoperative moderate to severe wound pain | 266 (46%) | 128 (54%) | 0.63 (0.45–0.88) | 0.007 |
Postoperative severe wound pain | 40 (7%) | 24 (10%) | 0.50 (0.27–0.90) | 0.022 |
PONV | 369 (64%) | 117 (49%) | 1.75 (1.27–2.41) | 0.001 |
Postoperative vomiting | 212 (37%) | 40 (17%) | 2.65 (1.79–3.92) | <0.001 |
Fentanyl Infusion Rate in ivPCA | Adjusted OR (95% CI) | p Value | |
---|---|---|---|
CSE | Without ivPCA | 1.00 (reference) | - |
Low rate (<0.42 μg/kg/h) | 1.41 (0.92–2.17) | 0.070 | |
High rate (≥0.42 μg/kg/h) | 2.38 (1.58–3.58) | <0.001 | |
Postoperative moderate to severe wound pain | Without ivPCA | 1.00 (reference) | - |
Low rate (<0.42 μg/kg/h) | 0.56 (0.38–0.82) | 0.003 | |
High rate (≥0.42 μg/kg/h) | 0.67 (0.46–0.97) | 0.034 | |
Postoperative severe wound pain | Without ivPCA | 1.00 (reference) | - |
Low rate (<0.42 μg/kg/h) | 0.40 (0.20–0.81) | 0.010 | |
High rate (≥0.42 μg/kg/h) | 0.54 (0.25–1.05) | 0.071 | |
PONV | Without ivPCA | 1.00 (reference) | - |
Low rate (<0.42 μg/kg/h) | 1.20 (0.84–1.73) | 0.316 | |
High rate (≥0.42 μg/kg/h) | 2.56 (1.77–3.72) | <0.001 | |
Postoperative vomiting | Without ivPCA | 1.00 (reference) | - |
Low rate (<0.42 μg/kg/h) | 2.05 (1.33–3.17) | 0.001 | |
High rate (≥0.42 μg/kg/h) | 3.25 (2.14–4.93) | <0.001 |
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Hamada, M.; Takeda, C.; Dong, L.; Hirotsu, A.; Shizuya, I.; Mizota, T. Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study. J. Clin. Med. 2022, 11, 3235. https://doi.org/10.3390/jcm11113235
Hamada M, Takeda C, Dong L, Hirotsu A, Shizuya I, Mizota T. Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study. Journal of Clinical Medicine. 2022; 11(11):3235. https://doi.org/10.3390/jcm11113235
Chicago/Turabian StyleHamada, Miho, Chikashi Takeda, Li Dong, Akiko Hirotsu, Izumi Shizuya, and Toshiyuki Mizota. 2022. "Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study" Journal of Clinical Medicine 11, no. 11: 3235. https://doi.org/10.3390/jcm11113235