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Published on: November 10, 2014
Association between fentanyl dose and willingness to undergo repeat bronchoscopy in a standardized EBUS-GS-TBB
Kazuya Monden1, Ayumi Akamatsu1, Yohei Takada1
1Department of Respiratory Center, Shinko Hospital, 1-4-47 Wakinohama-cho, Chuo-ku, Kobe, Hyogo, 651-0072, Japan.
Background:
Discomfort experienced during bronchoscopy may limit patients' willingness to undergo repeat procedures. Although guidelines recommend benzodiazepine-opioid sedation, evidence regarding optimal opioid dosing remains limited. We evaluated whether the total fentanyl dose was associated with willingness to undergo repeat bronchoscopy in a standardized endobronchial ultrasonography with guide-sheath transbronchial biopsy (EBUS-GS-TBB) setting.
Methods:
We conducted a retrospective single-center study of consecutive patients who underwent radial endobronchial ultrasonography with guide-sheath transbronchial biopsy. Patients were categorized by fentanyl dose: none (0 μg), low (1-49 μg), and moderate (≥50 μg). The primary outcome was willingness to undergo repeat bronchoscopy, assessed on a 5-point Likert scale (lower scores indicate greater willingness). Ordinal logistic regression was conducted using complete case analysis. Sensitivity analyses were conducted using alternative dose thresholds and continuous dose modeling.
Results:
Among 300 patients with evaluable primary outcome data, moderate-dose fentanyl was independently associated with greater willingness to undergo repeat bronchoscopy (adjusted odds ratio, 0.49; 95% confidence interval, 0.27-0.91), whereas low-dose fentanyl was not. The associations remained consistent in direction across different categorizations, and the continuous model demonstrated a dose-response relationship. Severe adverse events included two cases of pneumothorax requiring chest drainage in the moderate-dose group; no other severe events were noted.
Conclusions:
In this standardized EBUS-GS-TBB setting, moderate-dose fentanyl was associated with greater willingness to undergo repeat bronchoscopy. These findings suggest that willingness to undergo repeat bronchoscopy may depend not only on opioid use, but also on how opioids are titrated.
