Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial

Andrew Casamento; Angajendra Ghosh; Victor Hui; Ary Serpa Neto

doi:10.1016/j.ccrj.2023.11.004

Hospital and long-term opioid use according to analgosedation with fentanyl vs. morphine: Findings from the ANALGESIC trial

Crit Care Resusc. 2024 Jan 11;26(1):24-31. doi: 10.1016/j.ccrj.2023.11.004. eCollection 2024 Mar.

Authors

Andrew Casamento^{1

2

3}, Angajendra Ghosh^{2

3

4}, Victor Hui^{5

6}, Ary Serpa Neto^{1

3

6

7

8}

Affiliations

¹ Department of Intensive Care, Austin Hospital, Melbourne, Australia.
² Department of Intensive Care, Northern Hospital, Melbourne, Australia.
³ Department of Critical Care, University of Melbourne, Melbourne, Australia.
⁴ Department of Medical Education, University of Melbourne, Melbourne, Australia.
⁵ Department of Anaesthesia, Austin Hospital, Melbourne, Australia.
⁶ Data Analytics Research & Evaluation (DARE) Center, University of Melbourne and Austin Hospital, Melbourne, Australia.
⁷ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁸ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.

Abstract

Objectives: Opioid use disorder is extremely common. Many long-term opioid users will have their first exposure to opioids in hospitals. We aimed to compare long-term opioid use in patients who received fentanyl vs. morphine analgosedation and assess ICU related risk factors for long-term opioid use.

Design: We performed a post-hoc analysis of the Assessment of Opioid Administration to Lead to Analgesic Effects and Sedation in Intensive Care (ANALGESIC) cluster randomised crossover trial of fentanyl and morphine infusions for analgosedation in mechanically ventilated patients.

Setting: Two mixed, adult, university affiliated intensive care units in Melbourne, Australia.

Participants: Adult patients who were mechanically ventilated and received fentanyl or morphine for analgosedation in the ANALGESIC trial.

Main outcome measures: We assessed discharge and long-term (90-365 days) opioid use in opioid-naïve patients at hospital admission according to the agent used for analgosedation.

Results: We studied 477 patients (242 fentanyl and 235 morphine). There were no differences between discharge (16.5% vs. 14.0%, p = 0.45), 90-180 day post-discharge use (3.7% vs 2.1%, p = 0.30) or 180-365 day post-discharge use (3.4% vs 1.3%, p = 0.22) of opioids when comparing those patients who received fentanyl vs. those who received morphine. Surgical diagnosis and one chronic condition were associated with increased hospital discharge prescription of opioids, whereas increasing APACHE II score was associated with decreased discharge prescription. No ICU-related factors were associated with long-term opioid use.

Conclusions: Approximately one in seven opioid-naïve patients who receive analgosedation for mechanical ventilation in ICU will be prescribed opioid medications at hospital discharge. There was no difference in discharge prescription or long-term use of opioids depending on whether fentanyl or morphine was used for analgosedation.

Keywords: Analgosedation; Fentanyl; Long-term opioid use; Mechanical ventilation; Morphine.