Non-Opiate Analgesics & CPAP May Prevent Postoperative Respiratory Depression

Fred Rotenberg, MD

To the Editor

After reading Dr. Eichhorn’s review of the 2009 ASA meeting patient safety exhibits and Dr. Overdyk’s letter regarding postoperative opioid use in the winter 2009-2010 APSF Newsletter, I‘d like to add the following thoughts. We do have better ways of reducing postoperative pain and opiate-associated respiratory depression; they were demonstrated at last year’s ASA meeting. Specifically, using non-opiate analgesics reduces postoperative opiate requirements and therefore opiate-associated side effects. In the scientific exhibits the group from Temple (or Hahnemann) University demonstrated the use of postoperative intravenous ketamine infusion as an effective and safe alternative to systemic opiates. Clearly, other available modalities of providing better and safer analgesia exist (e.g., regional anesthesia and other systemic non-opiate analgesics).1,2 We should pursue the use of these and other analgesic alternatives.

Secondly, we should encourage the use of immediate postoperative continuous positive airway pressure (CPAP) for patients following abdominal surgery in the obese population or those with sleep apnea. Two disposable CPAP masks were presented by vendors at the meeting. Recent literature supports immediate and continued use of CPAP.3,4 Now with the availability of inexpensive disposable masks, such treatment is readily available.

Both the use of non-opiate analgesics and postoperative CPAP will help reduce postoperative respiratory failure. Let’s use them!

Fred Rotenberg, MD
Providence, RI


References

  1. Remerand, et al. The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective randomized, controlled, double-blind study. Anesth Analg 2009;109:1963-71.
  2. Buvanendran, et al. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 2010;110:199-207.
  3. Neligan, et al. Continuous positive airway pressure via the Boussignac system immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesthesiology 2009;110:878-84.
  4. Ferreyra et al. Continuous positive airway pressure for treatment of respiratory complications after abdominal surgery: a systematic review and meta-analysis. Ann Surg 2008;247:617-26.