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Background <p>Extended stays in the postanesthesia care unit (PACU) pose challenges in high-volume endoscopies. This study investigates the impact of intraoperative fentanyl use on PACU duration, postoperative pain, and financial implications in outpatient endoscopy.</p> Method <p>A retrospective analysis of upper/lower endoscopies at our facility (2020–2022) was conducted, focusing on the relationship between fentanyl use, PACU duration, and pain scales. Financial impacts were also assessed.</p> Results <p>Among 11,488 patients, 5787 (50.4%) received intraoperative fentanyl, and 5225 (45.5%) had a long stay at PACU (&gt; 50 min). A larger proportion of patients in the long-stay group (&gt; 50 min) received fentanyl (56.3% vs. 45.4%, <i>P</i> &lt; 0.01), and they reported higher Numeric Rating Scale (NRS) pain scores (&gt; 5 in 3.6% vs. 1.2%, <i>P</i> &lt; 0.01). The median PACU time was longer for fentanyl recipients (52 vs. 48 min, <i>P</i> &lt; 0.01). Multivariable analysis identified fentanyl use, older age, and higher ASA scores (≥ 3) as significant factors for prolonged PACU durations. Fentanyl did not significantly reduce postoperative pain (scores &gt; 5: 2.8% for fentanyl users vs. 2.2% for nonusers). Furthermore, most patients reported no pain post-surgery (93.0% for fentanyl users vs. 95.2% for nonusers). Fentanyl recipients did not have shorter PACU stays within any pain scale category. Financial simulations suggest that fentanyl-free anesthesia management could notably decrease the financial burden within endoscopy operations. Specifically, our institution could have realized an annual saving of at least US $100,308.</p> Conclusion <p>Intraoperative fentanyl increases PACU duration by approximately 4&#xa0;min per patient in endoscopies, without markedly improving pain management. Avoiding fentanyl could lead to significant time and cost savings.</p>

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Intraoperative fentanyl in endoscopic procedures and their impact on PACU time and costs

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月20日

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  • Miho Akabane,
  • Kelsey Kukuruza,
  • Timothy Angelotti,
  • Subhas Banerjee,
  • Kazuo Ando

摘要

Background

Extended stays in the postanesthesia care unit (PACU) pose challenges in high-volume endoscopies. This study investigates the impact of intraoperative fentanyl use on PACU duration, postoperative pain, and financial implications in outpatient endoscopy.

Method

A retrospective analysis of upper/lower endoscopies at our facility (2020–2022) was conducted, focusing on the relationship between fentanyl use, PACU duration, and pain scales. Financial impacts were also assessed.

Results

Among 11,488 patients, 5787 (50.4%) received intraoperative fentanyl, and 5225 (45.5%) had a long stay at PACU (> 50 min). A larger proportion of patients in the long-stay group (> 50 min) received fentanyl (56.3% vs. 45.4%, P < 0.01), and they reported higher Numeric Rating Scale (NRS) pain scores (> 5 in 3.6% vs. 1.2%, P < 0.01). The median PACU time was longer for fentanyl recipients (52 vs. 48 min, P < 0.01). Multivariable analysis identified fentanyl use, older age, and higher ASA scores (≥ 3) as significant factors for prolonged PACU durations. Fentanyl did not significantly reduce postoperative pain (scores > 5: 2.8% for fentanyl users vs. 2.2% for nonusers). Furthermore, most patients reported no pain post-surgery (93.0% for fentanyl users vs. 95.2% for nonusers). Fentanyl recipients did not have shorter PACU stays within any pain scale category. Financial simulations suggest that fentanyl-free anesthesia management could notably decrease the financial burden within endoscopy operations. Specifically, our institution could have realized an annual saving of at least US $100,308.

Conclusion

Intraoperative fentanyl increases PACU duration by approximately 4 min per patient in endoscopies, without markedly improving pain management. Avoiding fentanyl could lead to significant time and cost savings.