Table 3.
Incidence of Respiratory Depression with Epidural Analgesia – Adult Data
| Study, Year, Ref #(n) | Study Design | Epidural Opioid | Incidence of Respiratory Depression | Criteria |
|---|---|---|---|---|
| Wheatley, 2001(1) (1014 – > 1.3 million) | Review of RCTs | various | 0.24–1.6% | Various |
| Wheeler, 2002(19) (1596) | Review of RCTs | various | E: 1.9%
IV PCA: 1.8% IV/IM: 2.4% |
Various |
| Fischer, 1988 (37) (107) | Prospective | morphine fentanyl | 0% | “Clinically evident” |
| Ready, 1991(9) (1106) | Prospective | morphine | 0.2% | Naloxone use |
| Stuart-Taylor, 1992(13) (800) | Prospective | diamorphine | 0.9% | RR < 10/min |
| de Leon-Casasola, 1994a (4) (4227) | Prospective | morphine | 0.07% | RR < 10/min prompted use of naloxone per protocol. |
| Scott, 1995(11)(1014) | Prospective | fentanyl | RR<8/min: 1.2%,
Naloxone: 0.4% |
RR < 8 Naloxone use |
| Rygnestad, 1997 (10) (2000) | Prospective | morphine | Overall: 1.6%
Severe: 0.15% |
Considered severe if infusion was stopped. |
| Liu, 1998b (8)(1030) | Prospective | fentanyl | 0.3% | RR < 8/min |
| Flisberg, 2003(5) (2696) | Prospective | morphine | IV PCA: 1.2%
PCEA: 0.4% |
RR < 8/min |
| Shapiro, 2005(12) (1524) | Prospective | morphine | Overall: 1.2%
IV PCA: 1.9% E: 0.6% IT: 0.7% |
RR < 10/min |
| Burstal, 1998(38) (1062) | Prospective survey | various | 0.32% | RR < 8 and sedation |
| Fuller, 1990(6) (4880) | Retrospective | morphine | 0.25% | RR < 10/min |
| Tsui, 1997(14) (1466) | Retrospective | morphine fentanyl | IV PCA: 1.97%
E: 0.6% |
RR < 10/min
SpO2 < 90% PCO2 > 7kPa |
| Wigfull, 2001b (16) (1057) | Retrospective | fentanyl | 0.19% | RR < 8/min |
RCT = randomized controlled trial; E = epidural; IV = intravenous; PCA = patient controlled analgesia; IM = intramuscular; RR = respiratory rate; PCEA = patient controlled epidural analgesia; IT = intrathecal; SpO2 = arterial oxygen saturation; pCO2 = arterial carbon dioxide partial pressure.
a
Used intravenous morphine as supplementary analgesia.
b
Used patient-controlled epidural analgesia.
AU: PLS CHECK SUPERSCRIPTS AS THEY HAD TO BE CHANGED TO CONFORM TO JOURNAL STYLE. ALSO, IS THE ADDITION OF REF # TO COLUMN 1 OKAY WITH YOU?