Does IV fentanyl, frequently used in emergency departments, change QT value? A prospective observational study.

BACKGROUND

Fentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QT values of the patients or being monitored. However, the effect of fentanyl on QT, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QT.

METHODS

This is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QT value was calculated. Primary outcomes were QT prolongation, defined as an increase in the QT to ≥ 500 ms or any increase in QT by ≥ 60 ms.

RESULTS

The study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QT value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QT prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period.

CONCLUSION

Fentanyl prolonged the QT value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QT-prolonging effect should be considered when using fentanyl in patients at risk of torsades.