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A Single-Center Retrospective Observational Cohort Study on Postoperative Pain Management: Better with Continuous or Single Doses of Fentanyl with Acetaminophen?

Takashi Tennichi, Takumi Taniguchi

Objective: Continuous administration of opioids is a common approach after cardiac surgery. However, this method may be associated with a higher incidence of delirium. The present study aimed to evaluate the influence of two administration methods- continuous administration of fentanyl in combination with acute administration of fentanyl and acetaminophen vs. a combination of acute administration of fentanyl and acetaminophen only- on the incidence of delirium after cardiac surgery.

Methods: This retrospective observational cohort study enrolled 184 adult patients from 201 prospective participants who underwent elective cardiac surgery. After intensive care unit (ICU) admission, patients were divided into two groups: One group (group S) received administration of acetaminophen (15 mg·kg^-1 with a 6 hours lockout time). If administration of acetaminophen was not sufficient to control pain (numerical rating scale (NRS) score>3) throughout the lockout time, a single dose of fentanyl (25 μg bolus and 30 m lockout time) was administered. The other group (group C) began continuous administration of fentanyl (25 μg·h-1) immediately after ICU admission, and acetaminophen (l5 mg·kg^-1 and 6 h lockout time) was administered using the same protocol used for group S. For all patients, the incidence and duration of delirium and NRS scores were recorded.

Results: The incidence of delirium in group S was lower than that in group C (3.0% vs. 12.0%, p=0.021). Patients belonging to group S experienced a shorter duration of delirium than those in group C (8 vs. 20 hours, p=0.042). The NRS scores after ICU admission did not differ significantly between the two groups.

Conclusion: Continuous administration of postoperative fentanyl may cause an increased risk of postoperative delirium and prolong its duration. The combination of only acute administration of fentanyl and acetaminophen may be preferable because it reduces the frequency of postoperative delirium in cardiac surgery patients.