Does IV fentanyl, frequently used in emergency departments, change QT_C value? A prospective observational study

Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QT_C values of the patients or being monitored. However, the effect of fentanyl on QT_C, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QT_C.

This is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QT_C value was calculated. Primary outcomes were QT_C prolongation, defined as an increase in the QT_C to ≥ 500 ms or any increase in QT_C by ≥ 60 ms.

The study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QT_C value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QT_C prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period.

Fentanyl prolonged the QT_C value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QT_C-prolonging effect should be considered when using fentanyl in patients at risk of torsades.