Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery

• Published in: Journal of anesthesia Vol. 26; no. 4; pp. 503 - 508
• Main Authors: Iwata, Yoshika, Mizota, Yoko, Mizota, Toshiyuki, Koyama, Tomohiro, Shichino, Tsutomu
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.08.2012; Springer
• Subjects: Adolescent; Adult; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Analysis; Anesthesia, Intravenous; Anesthesiology; Body Mass Index; Cohort Studies; Complications and side effects; Critical Care Medicine; Early Ambulation; Emergency Medicine; Fainting; Female; Fentanyl - administration & dosage; Fentanyl - adverse effects; Fentanyl - therapeutic use; Gynecologic Surgical Procedures - adverse effects; Humans; Infusions, Intravenous; Intensive; Laparoscopic surgery; Laparoscopy; Laparoscopy - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Nausea; Opioids; Original Article; Orthostatic Intolerance - chemically induced; Orthostatic Intolerance - epidemiology; Pain Medicine; Postoperative Care - adverse effects; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Retrospective Studies; Treatment Outcome; Young Adult; Analgesia; Gynecologic laparoscopic surgery; Ambulation; Orthostatic intolerance; Opioids
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-012-1391-9

Purpose Early ambulation is essential for rapid functional recovery after surgery; however, orthostatic intolerance may delay recovery and cause syncope, leading to potential serious complications such as falls. Opioids may contribute to orthostatic intolerance because of reduced arterial pressure and associated reduction in cerebral blood flow and oxygenation. This study aimed to examine the effect of postoperative continuous infusion of fentanyl on orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery. Methods In this retrospective cohort study, data from 195 consecutive patients who underwent gynecologic laparoscopic surgery were analyzed to evaluate the association between postoperative continuous infusion of fentanyl and the incidence of orthostatic intolerance or delayed ambulation. The primary outcome was defined as delayed ambulation, an inability to ambulate on postoperative day 1. The secondary outcome was defined as orthostatic intolerance and symptoms associated with ambulatory challenge, including dizziness, nausea and vomiting, feeling hot, blurred vision, and eventual syncope. Multivariate logistic regression was used to determine the independent predictors of delayed ambulation and orthostatic intolerance. Results There were 24 cases with documented orthostatic intolerance and 5 with delayed ambulation. After multivariate logistic regression modeling, postoperative continuous infusion of fentanyl was found to be significantly associated with both orthostatic intolerance [adjusted odds ratio (95 % confidence interval), 34.78 (11.12–131.72)] and delayed ambulation [adjusted odds ratio (95 % confidence interval), 8.37 (1.23–72.15)]. Conclusion Postoperative continuous infusion of fentanyl is associated with increased orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery.