The Comparative Risk of Delirium with Different Opioids: A Systematic Review
Objective There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium fr...
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Published in | Drugs & aging Vol. 34; no. 6; pp. 437 - 443 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Cham
Springer International Publishing
01.06.2017
Springer Nature B.V |
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Abstract | Objective
There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients.
Methods
We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute.
Results
Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small.
Conclusion
Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed. |
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AbstractList | OBJECTIVEThere is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients.METHODSWe performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute.RESULTSSix studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small.CONCLUSIONSome data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed. There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients. We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute. Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small. Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed. Objective There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients. Methods We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute. Results Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small. Conclusion Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed. Included were studies written in English or Dutch, limited to randomized controlled trials, prospective and retrospective cohort studies, and case-control studies in hospital, long-term, or palliative care, with delirium as the outcome measure. The odds ratio (OR), hazard ratio, or relative risk with 95% confidence interval (CI) of each opioid for delirium were collected as the outcome measure. Characteristics of the included studies, including definition of delirium, dose of opioid, and timing of administration, were not comparable and often not available. Because of this clinical heterogeneity and lack of information, a meta-analysis was not performed. 4 Discussion In this systematic review, we aimed to investigate the difference in the risk of delirium from the use of various types of opioids in the elderly population. [...]delirium as a result of pain, not as a result of opioid use, might play an important role in the included studies. |
Author | Spies, Petra E. van der Zanden, Vera van Munster, Barbara C. Swart, Lieke M. de Rooij, Sophia E. |
Author_xml | – sequence: 1 givenname: Lieke M. orcidid: 0000-0002-0434-1203 surname: Swart fullname: Swart, Lieke M. email: l.m.swart@amc.uva.nl organization: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam – sequence: 2 givenname: Vera surname: van der Zanden fullname: van der Zanden, Vera organization: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam – sequence: 3 givenname: Petra E. surname: Spies fullname: Spies, Petra E. organization: Gelre Hospitals, Department of Geriatric Medicine – sequence: 4 givenname: Sophia E. surname: de Rooij fullname: de Rooij, Sophia E. organization: Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen – sequence: 5 givenname: Barbara C. surname: van Munster fullname: van Munster, Barbara C. organization: Gelre Hospitals, Department of Geriatric Medicine, Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28405945$$D View this record in MEDLINE/PubMed |
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There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between... There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the... Included were studies written in English or Dutch, limited to randomized controlled trials, prospective and retrospective cohort studies, and case-control... OBJECTIVEThere is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between... |
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SubjectTerms | Aged Analgesics Analgesics, Opioid - adverse effects Analgesics, Opioid - therapeutic use Delirium Delirium - chemically induced Drug dosages Evidence-based medicine Fractures Geriatrics Geriatrics/Gerontology Heart surgery Humans Hydromorphone - adverse effects Hydromorphone - therapeutic use Internal Medicine Joint surgery Medicine Medicine & Public Health Meperidine - adverse effects Meperidine - therapeutic use Metabolites Morphine - adverse effects Morphine - therapeutic use Narcotics Oxycodone - adverse effects Oxycodone - therapeutic use Pain Pain - drug therapy Pain Measurement - methods Pharmacology/Toxicology Pharmacotherapy Quality Risk Factors Systematic Review Tramadol - adverse effects Tramadol - therapeutic use |
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Title | The Comparative Risk of Delirium with Different Opioids: A Systematic Review |
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