British journal of anaesthesia
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Comment Letter Randomized Controlled Trial
Dexmedetomidine administration during brain tumour resection and postoperative delirium: a randomised controlled trial. Comment on Br J Anaesth 2023; 130: e307-e316.
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Observational Study
Intraoperative hydromorphone decreases postoperative pain: an instrumental variable analysis.
Intraoperative administration of short-acting opioids might lead to increased postoperative pain and opioid requirements. There are few data describing the effects of intermediate-duration opioids such as hydromorphone on these outcomes. We have previously shown that a switch from a 2 mg to a 1 mg vial of hydromorphone was associated with decreased intraoperative dose administration. As presentation dose affected intraoperative hydromorphone administration and was unrelated to other policy changes, it could serve as an instrumental variable, assuming significant secular trends were not present during the study period. ⋯ This study suggests that intraoperative administration of intermediate-duration opioids does not cause the same effects as short-acting opioids with respect to postoperative pain. Instrumental variables can be used to estimate causal effects using observation data when unmeasured confounding is present.