Postoperative opioids and risk of respiratory depression - A cross-sectional evaluation of routines for administration and monitoring in a tertiary hospital

Abstract

Objectives<p> Opioids are the most potent analgesics in the treatment of postoperative pain. Respiratory depression is, however, a serious side effect. The aims of this study were to evaluate current practice and routines for post-operative administration of opioids in a Norwegian university hospital and to evaluate whether the clinical safeguards adequately protected patients’ safety regarding risk of respiratory depression. <p>Methods <p>The study had a retrospective cross-sectional design and included 200 patients, treated with opioids postoperatively. The patients were treated in a post-anesthesia care unit (PACU) before transferal to a surgical ward. Relevant data such as opioid dosages, routes of administration, sedation and respiratory function, routines for patient monitoring, and numbers of patients with opioid induced respiratory depression was collected. <p>Results <p>Two patients (1%) developed respiratory depression that needed naloxone to reverse the effect, and 32 patients (16%) had a respiratory rate (RR) <10/min, which may have been caused by opioids. In the PACU, the patient’s RR was evaluated on a routine base, but after transferal to a surgical ward RR documented in only 7% of the patients. <p>Conclusions<p>The lack of routines for patient monitoring, especially RR, represented a risk of not detecting opioid induced respiratory depression.