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. 2025 Mar 20;14(1):33.
doi: 10.1186/s13741-025-00515-x.

Intraoperative fentanyl in endoscopic procedures and their impact on PACU time and costs

Miho Akabane  1 , Kelsey Kukuruza  1 , Timothy Angelotti  1 , Subhas Banerjee  1 , Kazuo Ando  2   3
Affiliations

Intraoperative fentanyl in endoscopic procedures and their impact on PACU time and costs

Miho Akabane et al. Perioper Med (Lond). .

Abstract

Background: Extended stays in the postanesthesia care unit (PACU) pose challenges in high-volume endoscopies. This study investigates the impact of intraoperative fentanyl use on PACU duration, postoperative pain, and financial implications in outpatient endoscopy.

Method: A retrospective analysis of upper/lower endoscopies at our facility (2020-2022) was conducted, focusing on the relationship between fentanyl use, PACU duration, and pain scales. Financial impacts were also assessed.

Results: Among 11,488 patients, 5787 (50.4%) received intraoperative fentanyl, and 5225 (45.5%) had a long stay at PACU (> 50 min). A larger proportion of patients in the long-stay group (> 50 min) received fentanyl (56.3% vs. 45.4%, P < 0.01), and they reported higher Numeric Rating Scale (NRS) pain scores (> 5 in 3.6% vs. 1.2%, P < 0.01). The median PACU time was longer for fentanyl recipients (52 vs. 48 min, P < 0.01). Multivariable analysis identified fentanyl use, older age, and higher ASA scores (≥ 3) as significant factors for prolonged PACU durations. Fentanyl did not significantly reduce postoperative pain (scores > 5: 2.8% for fentanyl users vs. 2.2% for nonusers). Furthermore, most patients reported no pain post-surgery (93.0% for fentanyl users vs. 95.2% for nonusers). Fentanyl recipients did not have shorter PACU stays within any pain scale category. Financial simulations suggest that fentanyl-free anesthesia management could notably decrease the financial burden within endoscopy operations. Specifically, our institution could have realized an annual saving of at least US $100,308.

Conclusion: Intraoperative fentanyl increases PACU duration by approximately 4 min per patient in endoscopies, without markedly improving pain management. Avoiding fentanyl could lead to significant time and cost savings.

Keywords: Anesthesiology; Endoscopy; Fentanyl; Pain; Postanesthesia care unit (PACU).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institutional Review Board (protocol number is 72022). Consent for publication: I confirm that I understand Perioperative Medicine is an open-access journal that levies an article processing charge per articles accepted for publication. By submitting my article, I agree to pay this charge in full if my article is accepted for publication. Competing interests: S.B. is a consultant for Boston Scientific.

Figures

Fig. 1
Fig. 1
Correlation between postoperative pain score and PACU stay duration
See this image and copyright information in PMC

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