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Orthostatic Intolerance Ambulation in Patients Using Patient Controlled Analgesia

  • Received : 2012.10.19
  • Accepted : 2013.02.27
  • Published : 2013.07.01

Abstract

Background: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. Methods: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. Results: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). Conclusions: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

Keywords

References

  1. Bundgaard-Nielsen M, Jørgensen CC, Jørgensen TB, Ruhnau B, Secher NH, Kehlet H. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth 2009; 102: 756-62. https://doi.org/10.1093/bja/aep083
  2. Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation 2005; 111: 2997- 3006. https://doi.org/10.1161/CIRCULATIONAHA.104.482018
  3. Perna GP, Ficola U, Salvatori MP, Stanislao M, Vigna C, Villella A, et al. Increase of plasma beta endorphins in vasodepressor syncope. Am J Cardiol 1990; 65: 929-30. https://doi.org/10.1016/0002-9149(90)91442-9
  4. Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg 1999; 89: 1352-9.
  5. Kim DH, Cho DH. The effect of combination of ondansetron and droperidol on prevention of postoperative nausea and vomiting. J Korean Pain Soc 2001; 14: 46-50.
  6. Cowie DA, Shoemaker JK, Gelb AW. Orthostatic hypotension occurs frequently in the first hour after anesthesia. Anesth Analg 2004; 98: 40-5.
  7. Long JS. Regression models for categorical and limited dependent variables. Thousand Oaks (CA), Sage Publications. 1997, p 54.
  8. Lee YY, Kim KH, Yom YH. Predictive models for post-operative nausea and vomiting in patients using patient-controlled analgesia. J Int Med Res 2007; 35: 497-507. https://doi.org/10.1177/147323000703500409
  9. Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg 2005; 101: 1343-8. https://doi.org/10.1213/01.ANE.0000180204.64588.EC
  10. Mizota T, Iwata Y, Daijo H, Koyama T, Tanaka T, Fukuda K. Orthostatic intolerance during early mobilization following video-assisted thoracic surgery. J Anesth 2013 [in press].
  11. Jans Ø, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. Br J Anaesth 2012; 108: 436-43. https://doi.org/10.1093/bja/aer403
  12. Crawford ME, Møiniche S, Orbaek J, Bjerrum H, Kehlet H. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery. Anesth Analg 1996; 83: 1028-32. https://doi.org/10.1213/00000539-199611000-00022
  13. Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA. Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 2005; 19: 1165-9. https://doi.org/10.1089/end.2005.19.1165

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