What Factors Help Predict Postoperative Fentanyl Use in IBD?

Eight factors may help predict an increasing or decreasing effect on postoperative fentanyl consumption in patients with inflammatory bowel disease (IBD), according to study findings published in BMC Anesthesiology.

For the analysis, investigators retrospectively reviewed the medical records of 179 patients with IBD from a hospital in Japan. Individuals with IBD who underwent open abdominal surgery and received postoperative intravenous fentanyl patient-controlled analgesia (PCA) between June 2013 and April 2017 were included in the analysis. All patients received a continuous infusion of fentanyl with additional bolus doses available via a PCA device. Researchers also collected patient data, including demographics, preoperative blood test information, operative reports, disease characteristics, and postoperative results. Investigators selected variables from these patient datasets that could help predict postoperative opioid consumption, such as disease condition, analgesia, inflammation, and extent of surgery.

Study participants had a mean age of 37.3±13.3 years; 72.6% were men; the mean intraoperative fentanyl consumption was 12.6±4.2 mcg; and the mean postoperative fentanyl consumption was 30.7±14.1 mcg/kg/d.

The primary outcome was the use of fentanyl per kilogram of body weight in the first 24 hours after surgery.

Of 8 statistically significant predictive variables resulting from the stepwise-selection method, 5 indicated a significant increasing effect on fentanyl consumption following surgery: ulcerative colitis (12.9%), current smoking status (11.1%), intraoperative fentanyl consumption (2.3%), receiving treatment with biologics within the month prior to surgery (8.4%), and using supplementary analgesics (6.6%). Patients with ulcerative colitis required more fentanyl than patients with Crohn disease.

Conversely, 3 predictive variables had a statistically significant decreasing effect on postoperative fentanyl consumption: age (0.7%), droperidol concentration in the PCA solution (2.1%), and diabetes (20.4%). The use of an abdominal nerve block did not have a significant effect on fentanyl use.

The biggest study limitation, according to the researchers, was that opioid consumption due to a PCA is not always directly reflective of pain or efficacy of the opioid.

“These factors may help clinicians optimize postoperative opioid doses to avoid insufficient pain management and complications due to opioid overdose,” the study authors noted.

Reference

Tsuboi S, Kubota K, Mihara T, Taguri M, Inagawa G, Goto T. Predictive factors of postoperative fentanyl consumption in patients with inflammatory bowel disease: A retrospective cohort study. BMC Anesthesiol. Published online March 11, 2022. doi:10.1186/s12871-022-01606-8

This article originally appeared on Gastroenterology Advisor