Comparison of the Effect of Intraoperative Morphine and Fentanyl on Discharge Readiness in Patients Undergoing Elective Day-Case Endoscopy: A Natural Experiment
Keywords:
ambulatory surgical procedure, endoscopy, fentanyl, morphine, procedural sedationAbstract
Objective: This study assessed whether morphine, compared to fentanyl, delayed fitness for discharge in patients undergoing day-case gastrointestinal (GI) endoscopy. Materials and methods: Using a retrospective observational design with a natural experiment framework, we compared two groups created by unpredictable fentanyl shortages that prompted morphine use without changes to caregivers or care: the fentanyl and the morphine groups. Data came from pre-anesthetic, intraoperative, and post-anesthesia care unit (PACU) records at Srinagarind Hospital, Khon Kaen University, from January 2021 to December 2022. The primary outcome was time from PACU arrival to a post-anesthetic discharge scoring system (PADSS) score of 9 or more. Secondary outcomes were the PADSS sub- categories: vital signs, post-anesthetic activity, postoperative nausea and vomiting (PONV), pain, and surgical bleeding. Analyses used Kaplan-Meier survival analysis. Results: Of the 442 patients (286 in the fentanyl group and 156 in the morphine group), the proportion achieving a PADSS score of 9 or more by 75 min was significantly higher in the fentanyl group (P < 0.001), but no significant differences remained at 90 min or later. The 75-min difference persisted after adjustment for opioid dose. Among sub-categories, patients in the fentanyl group reached full marks sooner in vital signs (P < 0.001) and activity (P < 0.001), with no significant differences in PONV (P = 0.81), pain (P = 0.62), or surgical bleeding (P = 0.16). Conclusion: In day-case GI endoscopy, discharge readiness at 75 min was more frequent with intraoperative fentanyl than morphine; no significant difference was detected thereafter.
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