Postoperative Opioid-Free Multistep Opiranserin Infusion Versus Fentanyl Patient-Controlled Analgesia After Breast or Minimally Invasive Gynecologic Surgery: A Retrospective Cohort Study
6 affiliations
- 1Department of Anesthesiology and Pain Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea
- 2Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
- 3Department of Obstetrics and Gynecology, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
- 4Department of Obstetrics and Gynecology, Chungnam National University Hospital, 33 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea
- 5Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
- 6Biomedical Research Institute, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
Abstract
Background/Objectives: Women undergoing breast or gynecologic surgery face high postoperative nausea and vomiting (PONV) risk, which often prompts discontinuation of opioid patient-controlled analgesia (PCA). Since anticipated opioid use is an Apfel risk factor, we examined a postoperative opioid-free analgesic regimen using opiranserin, previously evaluated only as an adjunct. Methods: In this single-center retrospective cohort study, 150 women undergoing breast or minimally invasive gynecologic surgery received a multistep opiranserin infusion via a PCA pump without demand boluses (n = 77) or fentanyl demand bolus PCA (n = 73). The opiranserin infusion ended at 10 h; fentanyl PCA remained connected throughout. The primary outcome was resting numeric rating scale (NRS, 0–10) at 24 h, by which time the infusion had been complete for 14–15 h; secondary outcomes were post-anesthesia care unit (PACU) and 6 h NRS, PONV, and early discontinuation. Results: Resting NRS did not differ significantly during the infusion (PACU p = 0.965; 6 h p = 0.675), with a larger difference at 24 h. The adjusted 24 h difference was 0.58 points higher with opiranserin (95% CI, 0.04 to 1.12; p = 0.036) by covariance analysis on pre-treatment covariates and 0.55 (0.02 to 1.09) by inverse-probability-of-treatment weighting; the point estimates were below the minimal clinically important difference of 1 point, but the confidence intervals do not exclude a clinically relevant increase in pain, and the estimate was nonsignificant after adjusting for non-opioid adjuncts (p = 0.177). Moderate or severe pain at 24 h was more frequent with opiranserin (19.5% vs. 8.2%; adjusted odds ratio, 3.76; 95% CI, 1.34 to 11.82). PONV (9.1% vs. 11.0%), rescue analgesia (26.0% vs. 17.8%), and early discontinuation (10.4% vs. 9.6%) were similar. Rescue opioids were available to both groups but used by one fentanyl-group patient and by none receiving opiranserin. Conclusions: The regimen eliminated postoperative opioid exposure, with resting pain scores that differed by less than 1 NRS point on average, although a clinically relevant increase cannot be excluded. With coverage fixed at 10 h, the 24 h difference cannot be separated into a shortfall of the agent and a shortfall of coverage. The anticipated PONV reduction was not observed, possibly in the context of low event rates and routine antiemetic prophylaxis.
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BibTeX
@article{kim2026postoperative,
title = {{Postoperative Opioid-Free Multistep Opiranserin Infusion Versus Fentanyl Patient-Controlled Analgesia After Breast or Minimally Invasive Gynecologic Surgery: A Retrospective Cohort Study}},
author = {Yeojung Kim and Mia Park and Sungho Choi and Juyeon Kim and Jinwoo Kim and Yeonsu Kim and Seounghun Lee and Chan Noh and Jiho Park},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208062},
url = {https://www.mdpi.com/2077-0383/15/20/8062},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Postoperative Opioid-Free Multistep Opiranserin Infusion Versus Fentanyl Patient-Controlled Analgesia After Breast or Minimally Invasive Gynecologic Surgery: A Retrospective Cohort Study
AU - Yeojung Kim
AU - Mia Park
AU - Sungho Choi
AU - Juyeon Kim
AU - Jinwoo Kim
AU - Yeonsu Kim
AU - Seounghun Lee
AU - Chan Noh
AU - Jiho Park
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208062
UR - https://www.mdpi.com/2077-0383/15/20/8062
AB - Background/Objectives: Women undergoing breast or gynecologic surgery face high postoperative nausea and vomiting (PONV) risk, which often prompts discontinuation of opioid patient-controlled analgesia (PCA). Since anticipated opioid use is an Apfel risk factor, we examined a postoperative opioid-free analgesic regimen using opiranserin, previously evaluated only as an adjunct. Methods: In this single-center retrospective cohort study, 150 women undergoing breast or minimally invasive gynecologic surgery received a multistep opiranserin infusion via a PCA pump without demand boluses (n = 77) or fentanyl demand bolus PCA (n = 73). The opiranserin infusion ended at 10 h; fentanyl PCA remained connected throughout. The primary outcome was resting numeric rating scale (NRS, 0–10) at 24 h, by which time the infusion had been complete for 14–15 h; secondary outcomes were post-anesthesia care unit (PACU) and 6 h NRS, PONV, and early discontinuation. Results: Resting NRS did not differ significantly during the infusion (PACU p = 0.965; 6 h p = 0.675), with a larger difference at 24 h. The adjusted 24 h difference was 0.58 points higher with opiranserin (95% CI, 0.04 to 1.12; p = 0.036) by covariance analysis on pre-treatment covariates and 0.55 (0.02 to 1.09) by inverse-probability-of-treatment weighting; the point estimates were below the minimal clinically important difference of 1 point, but the confidence intervals do not exclude a clinically relevant increase in pain, and the estimate was nonsignificant after adjusting for non-opioid adjuncts (p = 0.177). Moderate or severe pain at 24 h was more frequent with opiranserin (19.5% vs. 8.2%; adjusted odds ratio, 3.76; 95% CI, 1.34 to 11.82). PONV (9.1% vs. 11.0%), rescue analgesia (26.0% vs. 17.8%), and early discontinuation (10.4% vs. 9.6%) were similar. Rescue opioids were available to both groups but used by one fentanyl-group patient and by none receiving opiranserin. Conclusions: The regimen eliminated postoperative opioid exposure, with resting pain scores that differed by less than 1 NRS point on average, although a clinically relevant increase cannot be excluded. With coverage fixed at 10 h, the 24 h difference cannot be separated into a shortfall of the agent and a shortfall of coverage. The anticipated PONV reduction was not observed, possibly in the context of low event rates and routine antiemetic prophylaxis.
SN - 2077-0383
ER -