Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial.

Abstract Study objective Opioid administration for pain in general care floor patients remains common, and can lead to adverse outcomes, including respiratory compromise. The PRODIGY trial found that among ward patients receiving parenteral opioids, 46% experienced ≥1 respiratory depression episode. The objective of this analysis was to evaluate the geographic differences of opioid administration and examine the association between opioid administration characteristics and the occurrence of respiratory depression. Design Prospective observational trial. Setting 16 general care medical and surgical wards in Asia, Europe, and the United States. Patients 1335 patients receiving parenteral opioids. Interventions Blinded, alarm-silenced continuous capnography and pulse oximetry monitoring. Measurements Opioid-induced respiratory depression, defined as respiratory rate ≤ 5 bpm, SpO2 ≤ 85%, or ETCO2 ≤ 15 or ≥ 60 mmHg for ≥3 min; apnea episode lasting >30 s; or any respiratory opioid-related adverse event. Results Across all patients, 58% received only long-acting opioids, 16% received only short-acting ( Conclusions Despite varying opioid administration characteristics between Asia, Europe, and the United States, opioid-induced respiratory depression remains a common global problem on general care medical and surgical wards. While the use of post-procedure tramadol or post-procedure epidural opioids may reduce the incidence of respiratory depression, continuous monitoring is also necessary to ensure patient safety when receiving postoperative opioids. Registration number www.clinicaltrials.gov , ID: NCT02811302