Incidence of Delirium With Different Oral Opioids in Previously Opioid-Naive Patients.
Yosuke Sugiyama, Rei Tanaka, Tetsu Sato and 4 others
PMID 35045754WHAT IT FOUND
First-week delirium was 4.8% with oral morphine, 6.9% with oxycodone, and 6.7% with tapentadol in opioid-naive cancer patients.
Rates were similar.
Key findings
01Delirium occurred in 4.8% of the morphine group, 6.9% of the oxycodone group, and 6.7% of the tapentadol group.
02The incidence of delirium did not differ significantly between the oxycodone group and the morphine group, between the tapentadol group and the morphine group, or between the tapentadol group and the oxycodone group.
03Benzodiazepine use was significantly higher in the morphine group, 28.9%, than in the oxycodone group, 16.8%, and the tapentadol group, 8.9%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Opioid choice was made by the attending physician, not randomly assigned, so patients in the groups may have differed in ways that affect delirium risk. The study was retrospective and reviewed records, so delirium detection depended on what clinicians documented. The study was done at one hospital, so its results may not apply elsewhere. The tapentadol group had only 45 patients. The morphine group used benzodiazepines more often, and the tapentadol group used epidural ropivacaine more often; both can affect delirium risk. The average equivalent oral morphine dose differed between groups. Patients receiving tapentadol could also receive rapid-release morphine or oxycodone for breakthrough pain, so the tapentadol effect was not isolated. Electrolyte values were missing for some patients, and non-pharmacological delirium prevention practices may have varied by staff skill. Only the first week after starting opioid therapy was assessed, and patients discharged within one week were excluded.
Declared interests
The authors declared no conflict of interest, and the research received no specific funding.
The easy way to misread this
Do not conclude that one oral opioid is proven safer than another for preventing delirium. The study was retrospective, patients were not randomly assigned, and the groups differed in benzodiazepine and epidural ropivacaine use. It also looked only at the first week after starting therapy.