(S-169) THE APPROPRIATENESS OF NALOXONE ADMINISTRATION DURING THE POSTOPERATIVE PERIOD

(S-169) Green, C.R., Saturday 9:15

TITLE: THE APPROPRIATENESS OF NALOXONE ADMINISTRATION DURING THE POSTOPERATIVE PERIOD

AUTHORS: Carmen R. Green, MD, Sharon D. Minott, MD
AFFILIATION: University of Michigan, Ann Arbor, MI.

INTRODUCTION: The efficacy of epidural and intravenous (IV) opioids for postop analgesia is well established.¹ Naloxone (NAL) reverses the serious side effects of opioids: sedation, decreased mental acuity, and respiratory depression, but may cause detrimental cardiovascular side effects. A study was designed to evaluate the appropriateness of NAL administration in postop patients (pts) receiving epidural opioid analgesia (EOA) or IV patient controlled analgesia (PCA) while on the Acute Pain Service (APS) at a large midwestern tertiary care hospital.
METHODS: As part of continuous quality improvement, the APS database was queried for adult postop pts who received NAL during FY 1997/98. The medical record was reviewed for demographic data, type of postop analgesia (EOA or PCA), and the circumstances surrounding NAL use. To determine if opioid administration precipitated NAL administration, each case was reviewed and rated using a NAL appropriateness scale (NAS; 0=no contribution, 1=probable contribution, 2=probable causal factor). results are presented in a descriptive fashion.
RESULTS: 5053 pts utilized either EOA (n=1139) or PCA (n=3914) during the 12 month study period. Twenty pts received NAL (20/5053=0.4%). The distribution of patients receiving NAL consisted of EOA (6/1139=0.5%) vs. PCA (16/ 3914=0.3%). Seventeen charts were available for review. NAL was given appropriately to 76% of the pts (EOA=50% v PCA=91%) using NAS criteria (Table 1).

Table 1: Etiology of IV Naloxone Administration

	PCA	EOA	Total
Sedation	7	3	10
Desaturation	2	1	3
Hypotension	0	1	1
CNS Changes	2	1	3
Total	11	6	17

DISCUSSION: Our study revealed that EOA and IV PCA are safe and associated with a low incidence of detrimental side effects. Furthermore, the route of administration of opioids did not have an effect on the utilization of NAL. NAL was deemed appropriate for all patients in the PCA group whereas it was only appropriate for 3 patients in the EOA group. This preliminary study shows that continued surveillance and educational programs are necessary to enhance patient safety.
REFERENCE:

1. Anesthesiology 1987;67:787-91.