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Background <p>Opioid-related oversedation is associated with respiratory depression and can lead to potentially catastrophic adverse events in hospitalized patients. This study aimed to investigate influential factors for postoperative sedation during morphine-based intravenous patient-controlled analgesia (IV-PCA).</p> Methods <p>We enrolled patients who received morphine-based IV-PCA for postoperative pain at a medical hospital between January 2020 and November 2022. The primary outcome was unintentional sedation within 72&#xa0;h after surgery. The Observer Assessment of Alertness/Sedation Scale (OAA/S) was used to assess the sedation depth at 12-hour intervals. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) for the outcome of interest.</p> Results <p>A total of 1,461 patients were included for analyses. The multivariable analysis identified six independent factors for morphine-associated sedation, including age (aOR: 1.019, 95% CI: 1.008–1.030), current alcohol drinking (aOR: 2.14, 95% CI: 1.24–3.68), preoperative hemoglobin level (aOR: 0.41, 95% CI: 0.21–0.81, on base-2 logarithmic scale), intraoperative use of midazolam (aOR: 1.62, 95% CI: 1.07–2.45), basal morphine infusion (aOR: 2.08, 95% CI: 1.16–3.71), and duration of IV-PCA (aOR: 1.97, 95% CI: 1.09–3.57, on base-2 logarithmic scale). Basal morphine infusion was also associated with moderate-to-deep sedation (OAA/S score ≤ 3) (aOR: 2.75, 95% CI: 1.38–5.46). Furthermore, the combination of intraoperative midazolam use and basal morphine infusion was associated with an increased risk of sedation, suggesting a potential synergistic relationship.</p> Conclusion <p>The identified risk factors for morphine-associated oversedation can facilitate early identification and prevention of complications in high-risk populations. Our findings suggest that perioperative use of sedative-hypnotics and continuous opioid infusions should be approached cautiously in at-risk patients.</p>

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Risk factors for morphine-associated sedation in intravenous patient-controlled analgesia for postoperative pain

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月24日

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  • Jia-Rong Wu,
  • Hsiang-Ling Wu,
  • Yu-Ming Wu,
  • Juan P. Cata,
  • Jui-Tai Chen,
  • Yih-Giun Cherng,
  • Ying-Hsuan Tai

摘要

Background

Opioid-related oversedation is associated with respiratory depression and can lead to potentially catastrophic adverse events in hospitalized patients. This study aimed to investigate influential factors for postoperative sedation during morphine-based intravenous patient-controlled analgesia (IV-PCA).

Methods

We enrolled patients who received morphine-based IV-PCA for postoperative pain at a medical hospital between January 2020 and November 2022. The primary outcome was unintentional sedation within 72 h after surgery. The Observer Assessment of Alertness/Sedation Scale (OAA/S) was used to assess the sedation depth at 12-hour intervals. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) with 95% confidence interval (CI) for the outcome of interest.

Results

A total of 1,461 patients were included for analyses. The multivariable analysis identified six independent factors for morphine-associated sedation, including age (aOR: 1.019, 95% CI: 1.008–1.030), current alcohol drinking (aOR: 2.14, 95% CI: 1.24–3.68), preoperative hemoglobin level (aOR: 0.41, 95% CI: 0.21–0.81, on base-2 logarithmic scale), intraoperative use of midazolam (aOR: 1.62, 95% CI: 1.07–2.45), basal morphine infusion (aOR: 2.08, 95% CI: 1.16–3.71), and duration of IV-PCA (aOR: 1.97, 95% CI: 1.09–3.57, on base-2 logarithmic scale). Basal morphine infusion was also associated with moderate-to-deep sedation (OAA/S score ≤ 3) (aOR: 2.75, 95% CI: 1.38–5.46). Furthermore, the combination of intraoperative midazolam use and basal morphine infusion was associated with an increased risk of sedation, suggesting a potential synergistic relationship.

Conclusion

The identified risk factors for morphine-associated oversedation can facilitate early identification and prevention of complications in high-risk populations. Our findings suggest that perioperative use of sedative-hypnotics and continuous opioid infusions should be approached cautiously in at-risk patients.