Abstract
The administration of opioids is a central element in contemporary anesthetic techniques in Australia; however, opioids have a range of side effects. As an alternative, opioid-free anesthesia (OFA) is an emerging mode of anesthesia intended to avoid these side effects. This study is the first to publish the use of OFA in Australia and is conducted in a regional Queensland Health Service. The design will utilize a randomized clinical trial (RCT) to investigate the impact of OFA for patients having an elective laparoscopic cholecystectomy (n = 40) or tubal ligation (n = 40). Participant outcomes to be measured include: Quality of Recovery (QoR-15); Oral Morphine Equivalent Daily Dose (OMEDD) at 24-h post-operatively; time to first opioid (TTFO) dose; post-operative nausea and vomiting (PONV); Post Anesthetic Care Unit length of stay (PACU-LOS); and hospital length of stay (LOS). The findings may challenge the essentiality of opioids in the peri-operative period, which in turn would influence the future intra-operative management of surgical patients. Ultimately, a reduction in anesthesia-associated opioid use will support a more general decline in opioid use.
Highlights
Historical records indicate that humans have used opioids for at least 8000 thousand years as a mood enhancer, analgesic and hypnotic agent [1]
In Western contemporary health care practices, the use of opioids during anesthetic is evidenced-based, or is it? The Australian and New Zealand College of Anesthetists is cognizant of the rising prescription and risk of opioids
The millennia-long legacy of the “need” for opioids intra- and post-operatively appears unchallenged despite the advanced science that exists around human anatomy and physiology, pharmacokinetics and pharmacodynamics
Summary
Historical records indicate that humans have used opioids for at least 8000 thousand years as a mood enhancer, analgesic and hypnotic agent [1]. As White [6] indicates, ambulatory surgery involving high doses of opioids can be associated with increased post-operative complications including respiratory depression, paralytic ileus, nausea and vomiting, difficulty voiding, and pruritus. These can ironically increase length of stay, thereby reversing the objective of ambulatory surgery in providing rapid patient through-put. The measurement of Quality of Recovery (QoR) following anesthesia and surgery is broader than assessing pain management It involves considerations of the patient’s post-operative status in comparison to their pre-operative status and includes return of self-care, household and work activities and mobility to the level pre-operatively. Ethics Committee (HREC/2020/QRBW/62398), Queensland, Australia, and is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), trial number ACTRN12620000714987
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