Association of Opioid Administration During General Anesthesia and Survival for Severely Injured Trauma Patients: A Preplanned Secondary Analysis of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios (PROPPR) Study
Authors' conclusion
These results suggest that opioid administration during general anesthesia for severely injured patients is associated with improved survival, although the no-opioid group was more severely injured and hemodynamically unstable.
Study context
- Population
- Bleeding severely injured trauma patients undergoing anesthesia for an emergency procedure, 12 level 1 trauma centers in North America526 with complete anesthesia data
- Participants
- 680 participants
- Comparison
- Opioid dose groups vs no opioid during anesthesia
- Primary endpoint
- Mortality
- Follow-up
- 6 hours, 24 hours, and 30 days
Methodological detailspreplanned, post hoc, multicentre, generalized linear mixed model, No-opioid group more severely injured and hemodynamically unstable; opioid dose not randomized
- Preplanned
- Post hoc
- Multicentre
- Generalized linear mixed model
- No-opioid group more severely injured and hemodynamically unstable; opioid dose not randomized
Primary result
As reported in the abstract
Mortality, any opioid vs none
Odds ratio
0.02-0.04
CI 0.003–0.1P < 0.001
6 hours; adjusted
Odds ratio
0.01-0.03
CI 0.003–0.09P < 0.001
24 hours; adjusted
Odds ratio
0.04-0.08
CI 0.01–0.18P < 0.001
30 days; adjusted
Further findings
| Outcome | P value |
|---|---|
| 30-day mortality in those surviving >24 hours | P < 0.001 |
30-day mortality in those surviving >24 hours
- Lower mortality in any opioid dose group persisted
Other morbidity outcomes
- No other consistent associations of opioid dose with other morbidity outcomes
Safety
| Outcome | P value |
|---|---|
| VAP, lowest opioid dose group vs no opioidHigher VAP incidence; adjusted | P = 0.02 |
| Lung complications, third opioid dose group vs no opioid (survivors 24 hours)Lower | P = 0.03 |
Original publication
Association of Opioid Administration During General Anesthesia and Survival for Severely Injured Trauma Patients: A Preplanned Secondary Analysis of the PROPPR Study. Anesth Analg. Published 14 April 2023. doi:10.
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