Abstract
BackgroundSide effects related to intraoperative opioid administration are well known. Recently, it was found that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. Hence, peri-operative use of opioids might affect long-term oncological outcomes in cancer surgical patients. Opioid-free anaesthesia (OFA) is a methodology that dodges narcotic use during anaesthesia by using blends of several drugs added to common anaesthetic agents.The study aims to test the impact of OFA in transthoracic oesophagectomy in comparison with opioid-based anaesthesia technique (OBA) on postoperative analgesia and recovery criteria (hemodynamics, respiratory rate and haemoglobin oxygen saturation).ResultsThe postoperative VAS was significantly lower in OFA group (A) than OBA group (B) in the measured time points (immediate postextubation, 30 min, 2 and 4 h postoperative) with P values 0.001, 0.001, 0.0012 and 0.0065 respectively. The time passed till first rescue analgesia requested was significantly longer in OFA group (A) than OBA group (B) and the total dose of rescue analgesia given to the patients were significantly higher in group B than group A. The recorded postoperative respiratory rate was significantly faster in OBA group (B) than OFA group (A), and the haemoglobin oxygen saturation (SPO2) showed statistically significant lower values in the OBA group (B) than the OFA group (A).ConclusionsWe emphasise the perioperative safety and efficacy of the opioid-free anaesthesia techniques provided for transthoracic oesophagectomy with better postoperative analgesia and other post recovery criteria.Trial registrationWe carried out our trial at Ain-Shams University Hospitals, Cairo, Egypt, between June 2020 and November 2020. The study was approved by the Research Ethics Committee at the Faculty of Medicine, Ain Shams University and then registered in the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za/) with the following ID (PACTR202010907549506).
Highlights
Side effects related to intraoperative opioid administration are well known
Aim of the work The study aims to test the impact of Opioid-free anaesthesia (OFA) in transthoracic oesophagectomy in comparison with opioid-based anaesthesia technique (OBA) on postoperative analgesia and recovery criteria
The postoperative visual pain analogue scale (VAS) was significantly lower in OFA group (A) than OBA group (B) in the measured time points with P values 0.001, 0.001, 0.0012 and 0.0065 respectively, but at 6 h postoperative there was no statistical difference between both groups as P value was 0.45
Summary
It was found that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. Peri-operative use of opioids might affect long-term oncological outcomes in cancer surgical patients. The well-known side effects related to intraoperative opioid administration include neuroadaptation, and activation of pronociceptive processes named ‘opioid-induced hyperalgesia’ which interferes with opioids’ ability to provide long-term analgesia (Minkowitz et al, 2014; Simonnet & Rivat, 2003; Rivat & Ballantyne, 2016). Recent findings from retrospective, and experimental clinical trials, strongly suggest that opioids may inhibit cellular immunity through their effects on natural killer cell activity, stimulate angiogenesis and accentuate cancer cell growth. The opioids used peri-operatively might affect long-term oncological outcomes in oncological patients. This illustrates the current increase in using non-opioid medications as an alternative to opioids for pain relief during the perioperative time (Byrne et al, 2016)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
