ArticleAnesthesia and analgesia2025
Opioid Dose Variation in Cardiac Surgery: A Multicenter Study of Practice.
Article in Anesthesia and analgesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Efficacy and safety of intravenous methadone for pain management in cardiac surgery: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Impact of sedation with propofol and/or sufentanil on short-term outcomes in patients admitted to the intensive care unit: A retrospective study.The Journal of international medical research · 2026Article
- Patient-, Clinician-, and Institution-level Variation in Intraoperative Antihypertensive Use: A Multicenter Observational Analysis.Journal of cardiothoracic and vascular anesthesia · 2026Observational
- The Influence of Profession, Experience and Geographical Region on Intra- and Postoperative Opioid Practice in Denmark: A Post Hoc Analysis of the OPIAID Survey.Acta anaesthesiologica Scandinavica · 2026Article
- North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey.BJA open · 2025Article
- Opioid-free anaesthesia as a valuable alternative to opioid-based practices: evidence and future challenges.Pain management · 2025Review
- What is new in cardiac anesthesia in 2024?Journal of anesthesia and translational medicine · 2025Review
- Intraoperative Opioid Administration Variation in Cardiac Surgery: Predictable, Yet Not Personalized.Anesthesia and analgesia · 2025Article
- Enhanced Recovery After Surgery (ERAS) Protocols in Cardiac Surgery: Impact on Opioid Consumption.Journal of clinical medicine · 2025Article
- Intraoperative opioid administrations, rescue doses in the post-anaesthesia care unit and clinician-perceived factors for dose adjustments in adults: A Danish nationwide survey.Acta anaesthesiologica Scandinavica · 2025Article
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12 authors.
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Abstract
backgroundAlthough high-opioid anesthesia was long the standard for cardiac surgery, some anesthesiologists now favor multimodal analgesia and low-opioid anesthetic techniques. The typical cardiac surgery opioid dose is unclear, and the degree to which patients, anesthesiologists, and institutions influence this opioid dose is unknown.
methodsWe reviewed data from nonemergency adult cardiac surgeries requiring cardiopulmonary bypass performed at 30 academic and community hospitals within the Multicenter Perioperative Outcomes Group registry from 2014 through 2021. Intraoperative opioid administration was measured in fentanyl equivalents. We used hierarchical linear modeling to attribute opioid dose variation to the institution where each surgery took place, the primary attending anesthesiologist, and the specifics of the surgical patient and case.
resultsAcross 30 hospitals, 794 anesthesiologists, and 59,463 cardiac cases, patients received a mean of 1139 (95% confidence interval [CI], 1132-1146) fentanyl mcg equivalents of opioid, and doses varied widely (standard deviation [SD], 872 µg). The most frequently used opioids were fentanyl (86% of cases), sufentanil (16% of cases), hydromorphone (12% of cases), and morphine (3% of cases). 0.6% of cases were opioid-free. 60% of dose variation was explainable by institution and anesthesiologist. The median difference in opioid dose between 2 randomly selected anesthesiologists across all institutions was 600 µg of fentanyl (interquartile range [IQR], 283-1023 µg). An anesthesiologist's intraoperative opioid dose was strongly correlated with their frequency of using a sufentanil infusion (r = 0.81), but largely uncorrelated with their use of nonopioid analgesic techniques (|r| < 0.3).
conclusionsHigh-dose opioids predominate in cardiac surgery, with substantial dose variation from case to case. Much of this variation is attributable to practice variability rather than patient or surgical differences. This suggests an opportunity to optimize opioid use in cardiac surgery.
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