THE PLACE OF MULTIMODAL ANESTHESIA/ANALGESIA IN MODERN PERIOPERATIVE MANAGEMENT OF PATIENTS (REVIEW)

Abstract

One of the main directions of development of modern anesthesiology is the management of perioperative pain in order to limit the negative consequences of intra- and postoperative pain syndrome. Traditionally, opioids have played a central role in balanced anesthesia by helping control nociception and optimizing hemodynamics but have many side effects that prolong the patient's hospital stay and worsen the postoperative course, which increases the cost of medical care. The use of non-opioid or low-opioid anesthesia using paracetamol, dexmedetomidine, non-steroidal anti-inflammatory drugs, dexamethasone, lidocaine and ketamine has been found to reduce or avoid the use of opioids in patients in the perioperative period. The aim of this systematic review is to examine the available randomized controlled trials of nociceptive strategies in the perioperative period and evaluate them based on both subjective and objective measures of efficacy, safety, and cost-effectiveness. A systematic data search was conducted in the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, and publications in professional publications of Ukraine for 2013–2023. The search was conducted using the following keywords: opioids, opioid-free anesthesia, low-opioid anesthesia, perioperative period, pregnancy, paracetamol, dexmedetomidine, nonsteroidal anti-inflammatory drugs, dexamethasone, lidocaine, ketamine. Conclusion. Opioid-free and low-opioid anesthesia/anaesthesia strategies can improve the quality of treatment and patient safety but require further careful research.