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Pain Research and Management
Volume 20, Issue 1, Pages 23-28
Original Article

Impact of Age, Sex and Route of Administration on Adverse Events after Opioid Treatment in the Emergency Department: A Retrospective Study

Raoul Daoust,1,2 Jean Paquet,1,3 Gilles Lavigne,3,4 Éric Piette,1,2 and Jean-Marc Chauny1,2

1Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal, Canada
2Faculty of Medicine, Université de Montréal, Canada
3Centre for Advanced Research in Sleep Medicine and Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Canada
4Faculties of Dental Medicine and Medicine, Université de Montréal, Montréal, Québec, Canada

Copyright © 2015 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: The efficacy of opioids for acute pain relief in the emergency department (ED) is well recognized, but treatment with opioids is associated with adverse events ranging from minor discomforts to life-threatening events.

OBJECTIVE: To assess the impact of age, sex and route of administration on the incidence of adverse events due to opioid administration in the ED.

METHODS: Real-time archived data were analyzed retrospectively in a tertiary care urban hospital. All consecutive patients (≥16 years of age) who were assigned to an ED bed and received an opioid between March 2008 and December 2012 were included. Adverse events were defined as: nausea/vomiting (minor); systolic blood pressure (SBP) < 90 mmHg, oxygen saturation (Sat) < 92% and respiration rate < 10 breaths/min (major) within 2 h of the first opioid doses.

RESULTS: In the study period, 31,742 patients were treated with opioids. The mean (± SD) age was 55.8± 20.5 years, and 53% were female. The overall incidence of adverse events was 12.0% (95% CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea/vomiting, 2.4% (95% CI 2.2% to 2.6%) SBP < 90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that dropped to < 92% and 0.09% respiration rate < 10 breaths/min. After controlling for confounding factors, these adverse events were associated with: female sex (more nausea/vomiting, more SBP < 90 mmHg, less Sat < 92%); age ≥65 years (less nausea/vomiting, more SBP < 90 mmHg, more Sat < 92%); and route of administration (intravenous > subcutaneous > oral).

CONCLUSIONS: The incidence of adverse events associated with opioid administration in the ED is generally low and is associated with age, sex and route of administration.