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

## TL;DR

Using fentanyl during endoscopic procedures increases PACU time by 4 minutes per patient without improving pain relief, leading to higher costs.

## Contribution

This study is the first to show that fentanyl use in endoscopies prolongs PACU stays without better pain control, impacting hospital efficiency and costs.

## Key findings

- Fentanyl use was associated with 4-minute longer PACU stays and higher pain scores.
- Fentanyl-free anesthesia could save hospitals over $100,000 annually in endoscopy operations.
- Older age and higher ASA scores also contributed to prolonged PACU durations.

## Abstract

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.

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.

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.

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.

Fentanyl is frequently used in anesthesia for endoscopic procedures; however, the impact of fentanyl on postanesthesia care unit (PACU) stays has not been thoroughly investigated. Our findings reveal that the use of fentanyl prolongs PACU stays by 4 min without improving postoperative pain scores. While 5 min may seem short, when considering the high volume of procedures, the use of fentanyl significantly influences hospital management.