AANA Conference Coverage

Opioid Use During GI Procedures Linked to Lower Pain Scores and PONV

Miranda Manier, BA

Key Highlights

  • Intra/post-operative opioid use was associated with reduced odds of postoperative nausea and vomiting and lower post-anesthesia care unit (PACU) pain scores.
  • No overall association was found between opioid use and PACU length of stay.
  • The effects of opioids on outcomes varied by sex, anesthesia type, and use of preoperative antiemetics.
  • Findings suggest multimodal antiemetic regimens may offset opioid-related side effects, improving postoperative outcomes.

In a retrospective cohort analysis of 34,867 patients undergoing outpatient gastrointestinal (GI) procedures, intraoperative or postoperative opioid administration was associated with reduced postoperative nausea and vomiting (PONV) and lower maximum pain scores in the post-anesthesia care unit (PACU). This study was presented at the American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress.

With more than 70% of anesthesia care now delivered outside the operating room and millions of GI procedures performed annually in the United States, the demand for safe, efficient, and cost-effective anesthesia strategies continues to grow. While opioids remain effective for managing intraoperative pain, their use is often limited due to concerns over PONV, prolonged PACU stays, and long-term dependence. This study aimed to clarify the role of opioids in modern anesthesia practices by evaluating their impact on key recovery outcomes in a large outpatient GI population.

Researchers examined patients aged 18 and older who underwent esophagogastroduodenoscopy (EGD), colonoscopy, or esophagogastric ultrasound (EUS) between January 1 and December 31, 2023, at a single institution. Excluded procedures included endoscopic retrograde cholangiopancreatography and combined upper/lower endoscopic ultrasound cases. Data collection was conducted by the Anesthesia Clinical Research Unit (ACRU) and included demographic, clinical, procedural, and pharmacologic data. Primary outcomes were PACU length of stay (LOS), maximum PACU pain scores, and PONV incidence, with statistical modeling used to evaluate associations and moderators.

Among patients receiving opioids (n = 23,659), 80.7% reported no pain in the PACU compared with 84.6% in the non-opioid group (n = 11,208). Despite a slightly lower proportion reporting no pain, adjusted models showed that opioid use was significantly associated with lower odds of higher pain scores (OR 0.92; 95% CI, 0.86-0.98). Similarly, opioid use was linked to reduced odds of PONV (OR 0.82; 95% CI, 0.67-0.99). However, no significant association was observed between opioid use and PACU LOS (geometric mean ratio 0.99; 95% CI, 0.98-1.00).

Moderator analyses revealed that the effects of opioid use varied by sex, anesthesia type, and preoperative antiemetic administration. For example, opioids were associated with shorter PACU stays among men but not women, and with longer PACU stays in patients who received general anesthesia. Further analysis showed that patients in the opioid group were also more likely to receive multimodal antiemetic therapy, including ondansetron and dexamethasone.

As a retrospective study, limitations included the inability to control for provider preferences, drug availability, and clinical decision-making, which may have influenced outcomes.

“Our research aimed to examine the impact that opioids had on PACU outcomes,” Campos et al. concluded. “The primary findings indicated that patients who were administered opioids intra/post-operatively experienced a lower incidence of PONV and reduced pain scores in the PACU.”

Reference:
Campos R, Chhetri B, Kohrs K, et al. Evaluating patient outcomes in opioid versus non-opioid anesthesia for gastrointestinal procedures. Presented at: American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress; August 9–13, 2025; Nashville, TN. https://www.aana.com/premier-event/annual-congress/