BACKGROUND: Although the addition of a background infusion for intravenous patient-controlled analgesia (IV-PCA) has been identified as a risk factor for the development of respiratory depression, this has not clearly been examined in a systematic fashion. The authors undertook a systematic review and meta-analysis of available randomized controlled trials (RCTs) to examine whether the addition of a background or continuous infusion to an IV-PCA regimen would be associated with an increased risk of respiratory depression. METHODS: Studies were identified by searching the National Library of Medicine's PubMed database (1966 to November 30, 2008). Inclusion criteria were a clearly defined analgesic technique of demand-only IV-PCA versus IV-PCA utilizing both a demand dose and background infusion, opioid medication used, and randomized trials. Data were abstracted and analyzed with the RevMan 4.2.7 (The Cochrane Collaboration, 2004). RESULTS: The search yielded 687 abstracts from which the original articles were obtained and data abstracted with a total of 14 articles analyzed. There were 402 subjects in the continuous IV-PCA with demand group versus the 394 subjects in the demand-only IV-PCA group. Addition of a background infusion to the demand dose for IV-PCA with opioids was associated with a significant increased risk for respiratory depression (odds ratio [OR] = 4.68, 95% confidence interval [CI]: 1.20-18.21). Subgroup analysis revealed that this increased risk was seen in adult but not in pediatric patients. CONCLUSIONS: Our meta-analysis indicates that the addition of a continuous or background infusion to the demand dose for IV-PCA is associated with a higher incidence of respiratory events than demand IV-PCA alone in adult but not in pediatric patients; however, our overall results should be interpreted with caution due to the relatively small sample size and the wide range of definitions for respiratory depression in studies examined.
BACKGROUND: Although the addition of a background infusion for intravenous patient-controlled analgesia (IV-PCA) has been identified as a risk factor for the development of respiratory depression, this has not clearly been examined in a systematic fashion. The authors undertook a systematic review and meta-analysis of available randomized controlled trials (RCTs) to examine whether the addition of a background or continuous infusion to an IV-PCA regimen would be associated with an increased risk of respiratory depression. METHODS: Studies were identified by searching the National Library of Medicine's PubMed database (1966 to November 30, 2008). Inclusion criteria were a clearly defined analgesic technique of demand-only IV-PCA versus IV-PCA utilizing both a demand dose and background infusion, opioid medication used, and randomized trials. Data were abstracted and analyzed with the RevMan 4.2.7 (The Cochrane Collaboration, 2004). RESULTS: The search yielded 687 abstracts from which the original articles were obtained and data abstracted with a total of 14 articles analyzed. There were 402 subjects in the continuous IV-PCA with demand group versus the 394 subjects in the demand-only IV-PCA group. Addition of a background infusion to the demand dose for IV-PCA with opioids was associated with a significant increased risk for respiratory depression (odds ratio [OR] = 4.68, 95% confidence interval [CI]: 1.20-18.21). Subgroup analysis revealed that this increased risk was seen in adult but not in pediatric patients. CONCLUSIONS: Our meta-analysis indicates that the addition of a continuous or background infusion to the demand dose for IV-PCA is associated with a higher incidence of respiratory events than demand IV-PCA alone in adult but not in pediatric patients; however, our overall results should be interpreted with caution due to the relatively small sample size and the wide range of definitions for respiratory depression in studies examined.
Authors: Carlton D Dampier; Wally R Smith; Hae-Young Kim; Carrie Greene Wager; Margaret C Bell; Caterina P Minniti; Jeffrey Keefer; Lewis Hsu; Lakshmanan Krishnamurti; A Kyle Mack; Donna McClish; Sonja M McKinlay; Scott T Miller; Ifeyinwa Osunkwo; Phillip Seaman; Marilyn J Telen; Debra L Weiner Journal: Am J Hematol Date: 2011-09-22 Impact factor: 10.047
Authors: Amanda M Brandow; C Patrick Carroll; Susan Creary; Ronisha Edwards-Elliott; Jeffrey Glassberg; Robert W Hurley; Abdullah Kutlar; Mohamed Seisa; Jennifer Stinson; John J Strouse; Fouza Yusuf; William Zempsky; Eddy Lang Journal: Blood Adv Date: 2020-06-23
Authors: Erik M Helander; Bethany L Menard; Chris M Harmon; Ben K Homra; Alexander V Allain; Gregory J Bordelon; Melville Q Wyche; Ira W Padnos; Anna Lavrova; Alan D Kaye Journal: Curr Pain Headache Rep Date: 2017-01
Authors: Christopher J Voscopoulos; C Marshall MacNabb; Jordan Brayanov; Lizeng Qin; Jenny Freeman; Gary John Mullen; Diane Ladd; Edward George Journal: J Clin Monit Comput Date: 2014-07-19 Impact factor: 2.502