Opioid Anesthesia Research Articles

Opioids in anaesthesia

Opioids in anaesthesia

Patient Comfort During Postop Period in Breast Cancer Surgeries: A Randomized Controlled Trial Comparing Opioid and Opioid-Free Anesthesia.

Anesthetic management practices have advanced to opioid-free anesthesia (OFA) often replacing opioids in oncologic surgeries. The study was conducted to find the quality of recovery (QoR) of patients undergoing breast cancer surgeries receiving OFA. A double-blinded, randomized controlled study was conducted with 60 patients randomized to group OFA and group OA (opioid anesthesia). Group OFA received one-time dosing of ketamine 0.3 mg/kg, lignocaine 1.5 mg/kg, and dexmedetomidine 1 mcg/kg. Group OA received fentanyl 2mcg/kg. Intraoperatively, Group OFA received dexmedetomidine 0.4 mcg/kg/h and theOA group received fentanyl 0.5 mcg/kg/h infusion.Bispectral index (BIS), hemodynamics, muscle relaxant administration, and sevoflurane concentration were noted. A modified QoR-40 score was used to assess the quality of recovery in the postoperative period. A higher QoR-40 score was found in the OA group (median 182, IQR 178-186) compared to the OFA group (median 180, IQR 178-184). Out of the five components, the patient's emotional state was better in the group OA (39.9±2.77) than in the OFA group (37.9±2.77). The patient's physical comfort was found to be better in the group OFA (52.52±3.23) compared to group OA (50.93±3.23). Physical independence, psychological support, and pain were comparable between the two groups. Patients in group OFA received less sevoflurane, a muscle relaxant, and showed a mild reduction in heart rate and mean arterial pressure (MAP) when compared to group OA. The time taken to reach a Modified Aldrete score of 9 was high in OFA (11.47±2.16) and (9.17±1.09) when compared to group OA. No significant differences were noted with the visual analog score (VAS) score, Ramsay sedation score, and modified post-anesthesia discharge scoring system (PADSS) score. We conclude that the quality of recovery of patients receiving opioid-free methods of anesthesia was not inferior to OA in patients undergoing breast cancer surgeries.

OPIOID FREE GENERAL ANESTHESIA IN CLINICAL PRACTICE - A REVIEW ARTICLE.

Currently, enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways with the goal to achieve early patient recovery after surgery with minimal postoperative complications. According to studies, opioid free general anesthesia has many perioperative benefits and should be part of the ERAS protocols in specific surgical and patient indications. Opioid free general anesthesia is a multimodal balanced technique that is based on the concept that opioids are not used preoperatively or intraoperatively until the patient has aroused. The basic concept of opioid free general anesthesia is intravenous administration of several nonopioid drugs that operate at different pharmacological sites blocking surgical stress and sympathetic activation response. Moreover, current studies have shown that opioid free anesthesia is a technique which satisfactorily controls postoperative pain as the fifth vital sign, and has minimal side effects and better patient recovery with the same surgical conditions as general multimodal balanced anesthesia. However, further research is needed.

A comparison of postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) versus standard opioid anesthesia using intravenous tramadol (2 mg/kg) for preemptive analgesia in abdominal surgeries under general anesthesia

A comparison of postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) versus standard opioid anesthesia using intravenous tramadol (2 mg/kg) for preemptive analgesia in abdominal surgeries under general anesthesia

Effect of opioid anesthesia on radical postoperative complications in patients with esophageal cancer

Effect of opioid anesthesia on radical postoperative complications in patients with esophageal cancer

Comparative Study of Opioid Free versus Opioid Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Opioids have been used as a part of balanced anaesthesia and have known side effects. Opioid Free Analgesia is an emerging technique, based on avoiding intraoperative opioids.
 Aims: To compare the effectiveness of opioid-free versus opioid based anaesthesia.
 Methods: This comparative study involved 100 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia with American Society of Anaesthesiologists I or II physical status. Out of 100 patients, 50 received Fentanyl (Group A) while another 50 (Group B) received Ketamine and Lignocaine. Parameters measured and compared were the gender, age, weight, ASA physical status, hemodynamic stability, postoperative pain intensity (VAS) and opioid requirements, as well as side effects.
 Results: Both groups were comparable with regards to age, gender, weight, American Society of Anaesthesiologists I or II physical status, mean duration of surgery. There was no significant difference between groups hemodynamics at all assessed times (p>0.05) intraoperatively. Visual Analogue Scale pain score in the first 24 hours postoperatively showed that patients in Group A, at all analyzed time points had higher Visual Analogue Scale scores than Group B, but statistically significant difference was confirmed during the first hour (p = 0.001). Seven(14%) in Group A and 5(10%) patients in Group B got intravenous tramadol only once while 5(10%) patients in Group A required twice, which was statistically significant (p=0.05). Intraoperatively, 2 patients (4%) in group A had bradycardia while none in group B, which was statistically insignificant (p=0.153). Postoperatively, nausea was more in group A than Group B i.e. 8% vs 4% (p=0.4).
 Conclusion: Opioid Free anaesthesia has a better benefit over Opioid anaesthesia with regard to postoperative pain score, opioid consumption and its side effects.

Impact of opioid free anesthesia on glycemia: a randomized controlled trial

Background: General anesthesia induces frequently hyperglycemia. This is associated with an increased risk of morbidity and mortality in patients undergoing surgery. The type of anesthesia used may affect the severity of the peri-operative hyperglycemia. Methods: Patients undergoing an elective primary laparoscopic bariatric surgery at AZ Sint-Jan Brugge between February 2022 and March 2022 were randomized between opioid-free anesthesia (OFA) and opioid anesthesia (OA) after ethical approval. Any patient with diabetes type 1, diabetes type 2, having glucose intolerance at the time of surgery, or during pregnancy were excluded from the study. Dexmedetomidine, lidocaine, ketamine, and magnesium were used for the OFA, while sufentanil was given in the OA. No intravenously steroids were administered to protect the peritoneum nor as antiemetic prophylaxis. The increase in blood glucose level at 180’ was assessed as the primary outcome. A first measurement was taken just before the anesthesia induction (T0), followed by a measurement every hour (T60’, T120’, and T180’). As secondary endpoints, the total dose of opioids given in the first 24 hours and the postoperative pain using the VAS (visual analog scale) score were measured. Additionally, postoperative nausea and vomiting (PONV), duration of surgery, and surgical and/or anesthetic complications were recorded. Results: A total of 43 patients underwent an elective primary laparoscopic bariatric surgery. 22 patients received OFA and 20 patients received OA and were analyzed. One patient from the OA group withdrew written consent. 2 patients from the OFA group were lost to follow up having therefore 19 in the OA and 20 in the OFA for analysis. There were no significant differences between the two groups regarding age, BMI, gender, duration of surgery, and pre-induction glycemia. The glycemia level increased in both groups but increased significantly higher in the OA group at 180 minutes (Mann-Whitney test p = 0.027). OFA was associated with lower VAS scores postoperative (OFA: 3(2-4) vs OA: 4(4-5,5)) and a reduced need for postoperative opioids (OFA: 4.9(2,4-7,2) mg versus OA: 10,4(8,4-12,7) mg). Conclusion: This research suggest that the use of opioid-free anesthesia causes a smaller increase in glycemia during elective laparoscopic bariatric surgery compared to opioid anesthesia. Furthermore, patients undergoing OFA showed higher levels of postoperative comfort, demonstrated through the lower postoperative VAS scores and the reduced need for postoperative opioids.

Postoperative Nausea and Vomiting in Opioid-Free Anesthesia Versus Opioid Based Anesthesia in Laparoscopic Cholecystectomy.

Background: Postoperative nausea and vomiting (PONV) is a usual complication in patients undergoing laparoscopic cholecystectomy. Minimized opioid use due to surgery has been shown to have a better effect on patient recovery after surgery. In this study we evaluate the effect of opioid free anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy. Materials and methods: 80 patients aged 20-65 years old were included in this randomized, clinical and prospective trial. The patients belonged to the ASA classifications 1 and 2 and were scheduled for laparoscopic cholecystectomy. Patients were classified into two groups: group 1 (fentanyl group- FG), which included 40 patients who received opioid anesthesia, and group 2 (opioid free anesthesia group-OFAG) which included 40 patients who received opioid free anesthesia. In patients from group 1 (fentanyl group -FG) introduction to general anesthesia consisted of giving midazolam at 0.04 mg/kg, fentanyl at 0.002 mg/kg, 2 mg/kg of propofol and 0.6 mg/kg of rocuronium bromide. These patients received fractionated bolus doses of fentanyl during surgery. Prior to general anesthesia these patients did not receive dexamethasone. The patients from group 2 (opioid free anesthesia group - OFAG) received dexamethasone at 0.1 mg/kg and 1 g of paracetamol before introduction to anesthesia as a pre-emptive analgesia. Introduction to anesthesia consisted of giving midazolam at 0.04 mg/kg, lidocaine at 1 mg/kg, propofol at 2 mg/kg, ketamine at 0.5 mg/kg, and 0.6 mg/kg of rocuronium bromide. Immediately after intubation, continuous intravenous infusion with lidocaine at 2 mg/kg/h and magnesium sulfate at 1.5 g/h was given. In this group, fentanyl was not given either during the introduction of anesthesia or during the intraoperative period. Immediately after extraction of the gallbladder patients from group 2 (OFAG) received 2.5 g of metamizole intravenously. PONV were recorded in the postoperative period of 24 hours after surgery. Results: There was no significant difference with respect to age, weight, sex, duration of surgery, and anesthesia time. PONV at different time intervals were statistically not significant at all postoperative time points - 1 hr, 4 hr, 8 hr, 12 hr and 24 hr after surgery in fentanyl group compared to opioid free anesthesia group. Even not statistically significant, PONV have occurred more often in patients who received opioid anesthesia. Conclusion: Postoperative nausea and vomiting occurs more often in patients who received opioids during laparoscopic cholecystectomy compared to patients who received opioid free anesthesia, but without statistical significance.

Impact of opioid free Anaesthesia versus opioid Anaesthesia on the immediate postoperative oxygenation after bariatric surgery: a prospective observational study

Introduction: Opioid induced respiratory depression (OIRD) is a preventable aetiology of postoperative respiratory depression with 85% of the episodes taking place in the first 24 postoperative hours. Due to altered respiratory functional metrics and frequently coexisting comorbidities, obese patients are at a particularly higher risk for such complications. The present study aimed to assess if an opioid-free anesthesia (OFA) was associated with a reduced immediate postoperative OIRD when compared to Opiod-based anesthesia (OA). Methods: Obese patients presenting for bariatric surgery were consecutively included in a non-randomized fashion. Lung protective ventilation strategies applied in both groups. In the OA group, Sufentanil was used for intraoperative analgesia in a liberal fashion. In the OFA group, patients received a pre-induction dexmedetomidine loading, followed by a lidocaine, ketamine and dexmedetomidine bolus immediately before induction, further maintained throughout the intraoperative period. Plethysmographic saturations were obtained before induction as well as after extubation and in the Post-anesthesia care unit (PACU). Opioid requirement and Postoperative Nausea and Vomiting incidence were similarly registered. Results: Thirty-four patients were included in the OFA group, and 30 in the OA group. No significant anthropometric and comorbidity differences were found between both groups. OFA patients had significantly lower pre-induction saturations after dexmedetomidine loading. No difference was found for post-extubation saturations as well as well as pre-PACU discharge. The need for supplemental oxygen at the PACU was higher in the OA group. Opioid requirement and cumulative consumption (MEDs) were significantly higher with OA. Conclusion: OFA was not associated with significant postoperative saturation changes but led to a lower need of postoperative supplemental oxygen therapy. OA led to higher opioid rescue need. No fatal respiratory complications were registered in both groups in the immediate postoperative period.

Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study

BackgroundFew studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an effective analgesia-antinociception balance monitored by the / pain threshold index in laparoscopic radical colectomy.MethodsWe enrolled 102 patients undergoing laparoscopic radical colectomy with general anesthesia. Participants were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine (loading dose with 0.6 μg·kg−1 for 10 min and then 0.5 μg·kg−1·h−1 continuous infusion) and sevoflurane plus bilateral paravertebral blockade (0.2 μg·kg−1 dexmedetomidine and 0.5% ropivacaine 15 ml per side) or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and bilateral paravertebral blockade (0.5% ropivacaine 15 ml per side). The primary outcome variable was pain intensity during the operation, as assessed by the pain threshold index with the multifunction combination monitor HXD- I. Results were analyzed using repeated measures analysis of variance and Student’s t-test. The secondary outcomes were wavelet index, lactic levels, and blood glucose concentration during the operation. The visual analog scale (VAS), rescue analgesic consumption, and side-effects of opioids after surgery were further assessed.ResultsOne hundred and one patients were included in the analysis. Analysis revealed that the intraoperative pain threshold index readings were not significantly different between the groups from incision to the end of the operation (P = 0.06). Furthermore, similar changes in the brain wavelet index readings were observed in the OFA and OA groups. There was no statistical difference in VAS scores between the groups (P > 0.05); however, non-opioid anesthesia did reduce the rescue analgesic consumption after operation (P < 0.05). In the OFA group, the blood glucose levels increased by 20% compared to baseline and were significantly higher than those in the OA group (P < 0.001). The incidences of postoperative nausea and vomiting, urine retention, intestinal paralysis and pruritus were not significantly different from those in the OA group (P > 0.05).ConclusionsThis study suggests that compared to the opioid anesthesia regimen, our opioid-free anesthesia regimen achieved an equally effective intraoperative pain threshold index in laparoscopic radical colectomy. The incidence of opioid-related adverse reactions was not different between regimens, and intraoperative blood glucose levels were higher with opioid-free anesthesia.Trial registrationChiCTR1900021223, 02/02/2019, Title: " Opioid-free anesthesia in laparoscopic surgery: a randomized controlled trial ". Website: hppts://www.chictr.ogr.cn

Dexmedetomidine in the Program of Multimodal Low-opioid Anesthesia During Laparoscopic Surgery in Urology

Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic and analgesic effects. The objective: to evaluate the effectiveness of using dexmedetomidine in a multimodal low opioid anesthesia program for laparoscopic renal surgery. Materials and methods. 55 patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anesthesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC – 1.44±0.25 vol.%). In group 1 analgesia was provided with fentanyl 3.89±2.1 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl 2.38±1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2. The efficacy of antinociceptive protection was assessed by the dynamics of changes in the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations. Results. The total average doses of fentanyl used during the entire period of anesthesia were: 369.23±16.42 μg in group 1, 272.41±10,98 μg in group 2 (p&lt;0.001). In patients of the control group 1, an increase in the plasma concentration of adrenocorticotropic hormone by 111.86% (p&lt;0.01) from 25.7±2.1 pg/ml to 54.45±5.43 pg/ml was recorded (the study was conducted before the start of surgery and after the end of the operation), which was accompanied by a statistically significant increase cortisol concentration from 371.0±32.32 nmol/l to 562.72±45.37 nmol/l (by 51.67%) (p&lt;0.01). In patients of the second group (dexmedetomidine group), an intraoperative increase in the plasma concentration of adrenocorticotropic hormone was recorded from 26.25±2.3 pg/l to 46.88±2.36 pg/l (by 78.59%) (p&lt;0.01), which was accompanied by a statistically insignificant intraoperative increase in cortisol concentration from 393.51±25.0 nmol/l to 436.37±34.92 nmol/l – only by 10.89% (p&gt;0.05). Blood glucose concentrations in the early postoperative period in the both groups were 6.79±0.31 mmol/l and 6.29±0.24 mmol/l, respectively (p&gt;0.05). Hemodynamic parameters and BIS, which was maintained within 44±6.4%, indicated the adequacy of anesthesia and analgesia in both groups. Conclusions. The use of dexmedetomidine in multimodal low-opioid anesthesia for laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery.

The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes

Hip and knee arthroplasty (HKA) is a surgical procedure when damaged parts of the joint are replaced with artificial ones that replicate the shape of a normal joint and restore its function. Every year more than 1.5 million endoprosthetic operations are performed in the world. Replacement of a damaged joint allows patients to return to the normal life, freeing from pain and limited mobility. However, one of the common diseases that negatively affect the results of these operations is diabetes mellitus (DM). The aim of the study: to determine the efficacy and safety of the combined multimodal low opioid anesthesia with dexmedetomidine sedation in patients with diabetes undergoing HKA surgery. Materials and methods. The study included 45 patients who underwent HKA surgery. Patients were divided into three groups according to the scheme of anesthesia. In patients of the 1st group (n = 15) multicomponent low-flow anesthesia with artificial lung ventilation was performed, in the patients of the 2nd group (n = 15) spinal anesthesia was used, in the 3rd group (n = 15) – combined spinal – epidural anesthesia with dexmedetomidine sedation. The groups of patients were identical in anthropometric and gender characteristics, duration of surgery and anesthesia, baseline somatic status. Statistical analysis was performed using the IBM SPSS Statistics suite (SPSS v.16.0). Results. The course of anesthesia in patients in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting (PONV). Only one patient from group 3 required ondansetron for the treatment of PONV against 3 and 2 patients from groups 1 and 2, respectively (p &lt;0.05). Conclusions. Any of the proposed techniques can be used for anesthesia during hip and knee arthroplasty, but the best results have been obtained with combined spinal-epidural anesthesia with dexmedetomidine sedation. In addition, the use of dexmedetomidine can significantly reduce the use of opioids diring the intraoperative and postoperative period.

Opioid-free anaesthesia for laparoscopic surgeries - A prospective non-randomised study in a tertiary care hospital

Background and Aims:Opioids have nowadays become superfluous because of their adverse effects involving post-operative recovery of the patients. So, we aimed at comparing opioid-free anaesthesia with opioid-based technique for post-operative pain relief in laparoscopic surgeries. The primary objective was to assess the pain scores in the post-operative period using visual analogue scale (VAS) for 24 h, and the secondary objective was to compare intraoperative haemodynamic parameters, duration of postoperative analgesia and total analgesics consumed in the first 24 h.Methods:This study was conducted in 60 patients aged between 20 and 70 years, belonging to the American Society of Anesthesiologists physical class I and II posted for laparoscopic surgeries. Anaesthetic doses of lidocaine, magnesium and paracetamol in combination with fascial plane block for post-operative pain relief were given for 30 patients, and the other 30 patients received the conventional opioid-based anaesthesia. Mann–Whitney test was used for VAS scores, and Friedman test was used for repeated measures comparison.Results:VAS scores were higher in the conventional group as compared to the opioid-free group at 0, 2, 4, and 6 h during rest and at 0, 2, 4, 6, 24 h during movement and were statistically significant (P-value < 0.05). The duration of analgesia for the conventional group was 13.8 + 6.7 h, and for opioid-free anaesthesia was 6.7 + 2.2 hours. Intraoperative haemodynamic parameters did not show a statistically significant difference except for systolic blood pressure which was higher in the opioid-free group but was clinically insignificant. (P-value 0.013).Conclusion:Opioid-free anaesthesia along with erector spinae plane block provides better post-operative pain relief when compared to conventional opioid anaesthesia.

Application of Non-Opioids under the Concept of Enhanced Recovery after Surgery under Ultrasound-Guided Iliac Fascia Nerve Block Anesthesia in Elderly Patients with Hip Fracture Surgery

To discuss the application of enhanced recovery after surgery concept in ultrasound-guided iliac fascia nerve block in elderly hip fracture surgery patients and its effect on traumatic stress in patients during perioperative period. Selected 100 elderly patients undergoing hip fracture surgery in our hospital from January 2021 to September 2021. Divided 50 patients of non-opioid ultrasound-guided iliac fascia nerve block anesthesia into observation group and the other 50 patients of opioid (sufentanil) anesthesia into control group. Compared perioperative heart rate and mean arterial pressure indexes of both groups; compared visual analog scale, sedation-agitation scale and mini-mental state examination scores of patients on the 2 d after surgery; compared cortisol, C-reactive protein and interleukin-6 levels in serum of both groups. Compared Harris hip function score, perioperative complications (pressure sores, lower extremity venous thrombosis, lower limbs swelling, lung infection), length of hospital stay and hospitalization expenses of both groups at 3 mo after surgery. Observation group had lower mean arterial pressure and heart rate during spinal canal intubation than control group, which possessed statistical significance (p<0.05). On the 1 d after surgery, observation group had higher visual analog scale score than control group (p>0.05), but had remarkably lower sedation-agitation scale score than control group (p<0.05), and had remarkably higher mini-mental state examination score than control group (p<0.05). At 3 mo after surgery, observation group had higher affected hip joint Harris score than control group (p<0.05), and postoperative complications rate in observation group (8 %) was remarkably lower than control group (16 %), observation group had remarkably lower hospitalization expenses and length of stay than control group, so the divergence possessed statistical significance (p<0.05). Under the concept of enhanced recovery after surgery, nonopioids under ultrasound-guided iliac fascia nerve block anesthesia can better improve hip joint function, reduce postoperative cognitive dysfunction and reduce postoperative complications in geriatric hip fracture surgery. It can remarkably shorten the length of hospitalization and hospitalization expenses. Compared with traditional opioid spinal anesthesia, it can remarkably accelerate the recovery of patients after surgery.

A randomized trial with opioid-free versus opioid anesthesia in morbidly obese patients during laparoscopic cholecystectomy

ObjectivesThe present study is scheduled to compare the analgesic and sedative effects of opioid and dexmedetomidine during the perioperative period and also to compare the recovery characteristics and hemodynamics as secondary outcomes.BackgroundObesity is a risk factor for many diseases and complications including general anesthesia-related complications. Opioids have been used as part of balanced anesthesia and have known undesired side effects. Opioid-free anesthesia is an anesthetic technique without intraoperative systemic, neuraxial, or intracavitary opioids.Patients and methodsThis study was conducted during the period from June 2020 till May 2021 to compare the effectiveness of opioid-free anesthesia versus opioid-based general anesthesia on 60 morbidly obese patients of BMI more than 35 kg/m2, American Society of Anesthesiologists III, in the age range from 20 to 60 years and were undergoing laparoscopic cholecystectomy under general anesthesia. The patients were divided into two equal groups: group A for opioid-based anesthesia group (OA) (n = 30). They received general anesthesia with propofol, muscle relaxant, and fentanyl as the main anesthetic adjuvant and analgesic and group B for opioid-free anesthesia (OFA) (n = 30). They received general anesthesia with propofol, muscle relaxant, dexmedetomidine, ketamine and lidocaine as anesthetic adjuvant and analgesic.ResultsOpioid-free anesthesia provided perioperative hemodynamic stability, postoperative pain relief, less incidence of postoperative nausea and vomiting, acceptable patient sedation, satisfaction, and less analgesic consumption postoperatively than that of the opioid-based anesthesia in morbidly obese patients.ConclusionOpioid-free anesthesia may be an attractive solution for anesthesia management of the morbidly obese patients undergoing general anesthesia.

Impact of Opioid-free Anesthesia After Video-assisted Thoracic Surgery: A Propensity Score Study

BackgroundAdequate postoperative morphine consumption and pain management after thoracic surgery are major issues in the prevention of respiratory complications. Opioid-free anesthesia (OFA) may decrease morphine consumption and postoperative pain. The objective of this study was to evaluate the impact of OFA on the consumption of morphine and pain after video-assisted thoracic surgery or robotic-assisted thoracic surgery. MethodsThe main objective of this retrospective study with propensity score analysis (PSA) was to compare the cumulative postoperative morphine consumption at 48 hours between an OFA group receiving dexmedetomidine, lidocaine, and ketamine; and an opioid anesthesia (OA) group receiving remifentanil plus morphine. Postoperative pain at 24 and 48 hours and respiratory and hemodynamics complications were also assessed. ResultsEighty-one patients were included, 48 in the OFA group and 33 in the OA group. The cumulative postoperative morphine consumption at 48 hours was lower in the OFA group than in the OA group (28.5 mg [0 to 62.25 mg] vs 55 mg [34 to 79.5 mg], P = .002, with PSA; OFA −27.67 mg [−46 mg to −11.5 mg], P = .002). The postoperative pain score was significantly lower in the OFA group compared with the OA group at 24 hours (2 [0 to 4] vs 3 [2 to 5], P = .064, with PSA; OFA −1.40 [−2.47 to −0.33], P = .0088) and 48 hours (0 [0 to 3] vs 2.5 [0 to 5], P = .034, with PSA; OFA −1.87 [−3.45 to −0.28], P = .021). There were no differences between groups concerning respiratory or hemodynamic complications. ConclusionsOur results suggest that OFA after video-assisted thoracic surgery or robotic-assisted thoracic surgery is safe and is associated with less postoperative morphine cumulative consumption and pain at 48 hours.

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study.

Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. Patients (ASA Ⅰ-Ⅱ, 18-65 years old, BMI <30 kg m-2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD‑I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study's limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

Predicting the Membrane Permeability of Fentanyl and Its Analogues by Molecular Dynamics Simulations

The lipid membrane is considered a crucial component of opioid general anesthesia. The main drug used for the induction and maintenance of opioid anesthesia is fentanyl and its various analogues. However, these drugs have different clinical effects, and detailed atomic-level insight into the drug–membrane interactions could lead to a better understanding how these drugs exert their anesthetic properties. In this study, we have used extensive umbrella sampling molecular dynamics simulations to study the permeation process of fentanyl and three of its analogues into a variety of simple phospholipid membrane models. Our simulations show that we can accurately predict the permeability coefficients of these drug molecules, which is an important process in understanding how pharmaceuticals reach their molecular targets. We were also able to show that one phospholipid provides more accurate predictions than other lipids commonly used in these types of permeation studies, which will aid future studies of these types of processes.

Opioid free pain management in ambulatory hemorrhoidectomy reduces pain

Abstract Objective Outpatient hemorrhoid surgery is a topic of growing importance with a need of modifications to pain management to enable early discharge. Opioid free anesthesia and analgesia (OFAA) has the goal to reduce postoperative pain as well as to improve discharge circumstances. The impact of OFAA on patients receiving ambulatory hemorrhoidectomy is investigated. Methods A retrospective cohort study on ambulatory hemorrhoidectomy between 2018 and 2020 was performed and patients that did and did not receive OFAA were compared. In the OFAA group patients received spinal anesthesia with Takipril and hyperbaric technique. Additionally Metamizole 500mg i.v. and Paracetamol 1g i.v. was used. In the non-OFAA group opioids were administered intravenously (fentanyl or remifentanyl) and sublingual (buprenorphin). Primary endpoint was pain measured according to a numeric rating scale (NRS) one hour postoperatively. Secondary endpoints were pain 24 hours postoperative, duration of hospital stay, urinary retention, postoperative nausea and vomiting (PONV), overall morbidity, and re-admission. Wilcoxon Rank-Sum test was performed to search for differences between the outcomes. Results 117 patients were included in the analysis. 41 percent of the patients were female. The mean age was 54±14 years. 40 patients did not receive opioids perioperatively (OFAA group) and 77 did (non-OFAA group). The non-OFAA group received a mean dose of 23.3±17.9 mg morphine equivalent. Median NRS score one hour postoperatively was 0 (interquartile range 0-1) for OFAA and 2 (0-4) for non-OFAA (p = 0.01). The median NRS score 24 hours postoperatively was 1 (0-2) for OFAA and 1 (0-3) for non-OFAA (p = 0.40). There were 3 patients (7.5%) with urinary retention in OFAA and 5 patients (6.5%) in non-OFAA(p = 0.84).No patient had PONV in OFAA and 5 (6.5%) in non-OFAA (p = 0.10). The overall morbidity was 5 (12.5%) in OFAA and 16 (20.8%) in non-OFAA (p = 0.27). There were two readmissions (5%) in OFAA and 6 (7.8%) in non-OFAA (p = 0.58). Conclusion There is a significant difference in pain one hour postoperatively between OFAA and non-OFAA with a clear benefit of not administering opioids. Opioids may trigger pelvic floor spasms and disimprove postoperative pain. In the context of outpatient surgery, we recommend an opioid free operation to reduce postoperative pain and improve discharge prerequisites.

Heart rate variability in laparoscopic hysterectomy depending on different types of anesthesia

The objective: was to evaluate the effectiveness of various anesthesia options for laparoscopic hysterectomy, including low-opioid (LOA) and opioid-free anesthesia (OFA) by studying the dynamics of heart rate variability (HRV) indicators.Materials and methods. 102 patients were randomly assigned to 3 groups: 37 patients who received standard opioid anesthesia (control group), 33 women who received the LOA group, and 32 patients who received OFA.Results. Laparoscopic hysterectomy is accompanied by tension of the autonomic nervous system, especially its sympathetic link, which is manifested by an increase in the index of vago-sympathetic interaction at the traumatic stage of the operation. These changes were most significant in patients who received standard and opioid-free anesthesia, which indirectly indicates insufficient stress protection of these types of intraoperative anesthesia.Conclusions. The use of low-opioid anesthesia is accompanied by a greater stabilization of HRV indices, which indicates its sufficient autonomic protection during laparoscopic hysterectomy than standard and opioid-free anesthesia.