Opioid-free Anesthesia Research Articles

A comparative analysis of opioid-free and opioid-sparing anaesthesia techniques for laparoscopic ovariectomy in healthy dogs

ObjectiveTo compare the perioperative analgesic effects of an opioid-free (OFA) and an opioid-sparing (OSA) anaesthetic protocol in dogs undergoing laparoscopic ovariectomy. Study designProspective, randomized, blinded, clinical trial. AnimalsA group of 28 client-owned dogs. MethodsDogs were allocated to one of two groups. The OFA group was administered intramuscular (IM) dexmedetomidine 5 μg kg–1 and ketamine 1 mg kg–1, followed by two intraoperative constant rate infusions (CRIs) of dexmedetomidine (3 μg kg–1 hour–1) and lidocaine (1 mg kg–1 loading dose, 2 mg kg–1 hour–1). The OSA group was administered IM dexmedetomidine 5 μg kg–1, ketamine 1 mg kg–1 and methadone 0.2 mg kg–1, followed by two intraoperative saline CRIs. In both groups, anaesthesia was induced with intravenous (IV) propofol 2 mg kg–1 and diazepam 0.2 mg kg–1 and maintained with isoflurane. Rescue dexmedetomidine (0.5 μg kg–1) was administered IV if there was a 20% increase in cardiovascular variables compared with pre-stimulation values. Ketorolac (0.5 mg kg–1) was administered IV when the surgery ended. Postoperative analgesia was evaluated using the Short Form-Glasgow Composite Measure Pain Scale and methadone (0.2 mg kg–1) was administered IM if the pain score was ≥ 6/24. Statistical analysis included mixed analysis of variance, Chi-square test and Mann–Whitney U test. ResultsThere were no significant differences in the intraoperative monitored variables between groups. The OFA group showed a significantly lower intraoperative rescue analgesia requirement (p = 0.016) and lower postoperative pain scores at 3 (p =0.001) and 6 (p < 0.001) hours. No dogs were administered rescue methadone postoperatively. Conclusions and clinical relevanceAlthough both groups achieved acceptable postoperative pain scores with no need for further intervention, the analgesic efficacy of the OFA protocol was significantly superior to that of the OSA protocol presented and was associated with a lower intraoperative rescue analgesia requirement and early postoperative pain scores.

Retrolaminar block for opioid-free anaesthesia and enhanced recovery after posterior lumbar discectomy: A randomised controlled study.

Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial.

Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in 'opioid-free' and 'opioid-based' TCSA. After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into 'opioid-free' (bupivacaine alone) and 'opioid-based' (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02-0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2-0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher's exact tests. The 'opioid-based' group performed significantly better compared with the 'opioid-free' group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). The 'opioid-based' TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the 'opioid-free' group in patients undergoing major abdominal surgery.

Safety and effectiveness of opioid-free anaesthesia in thoracoscopic surgery: a preliminary retrospective cohort study

BackgroundThis study aimed to observe the effect of opioid-free anaesthesia (OFA) on intraoperative haemodynamic,postoperative analgesia and postoperative nausea and vomiting (PONV) in thoracoscopic surgery in order to provide more evidence for evaluating the safety and effectiveness of OFA technology.MethodsThis was a single-centre retrospective observational study.Adult patients who underwent thoracoscopic surgery with the preoperative thoracic paravertebral block between January 2017 and June 2020 were included.A cohort of 101 thoracoscopic surgery patients who received the OFA technique were matched with 101 thoracoscopic surgery patients who received standard opioid-containing anaesthesia(SOA). Heart rate (HR) and mean arterial blood pressure (MAP) were measured before anaesthesia induction, immediately after endotracheal intubation, at the beginning of surgery, and 10, 20, and 30 min after surgery began.The total amount of intraoperative infusion, frequency of vasoactive drugs use, morphine ingested via the patient-controlled intravenous analgesia (PCIA) 24 h post-surgery,visual analogue scale (VAS) scores at rest and activity on the first day post-surgery, and frequency of nausea and vomiting within 24 h post-surgery were analysed.ResultsThere was no significant difference in intraoperative HR between the two groups (F = 0.889, P = 0.347); however, there was significant difference in intraoperative MAP (F = 16.709, P < 0.001), which was lower in SOA patients than in OFA patients. The frequency of vasoactive drug use and amount of infusion was less in OFA patients (P = 0.001). The consumption of morphine used by the PCIA 24 h post-surgery was significantly lower in OFA patients (OFA, 1.8 [0, 4.8] mg vs. SOA, 3.6 [0.6, 23] mg, P < 0.001). There was no significant difference in VAS scores at rest (P = 0.745) or during activity (P = 0.792) on the first day post-surgery. There was also no statistically significant difference in nausea and vomiting within 24 h post-surgery (P = 0.651).ConclusionsThis case-control study demonstrated that compared with SOA, OFA can effectively maintain the stability of intraoperative MAP, reduce the incidence of hypotension. Although OFA reduced morphine consumption via the PCIA pump 24 h post-surgery, postoperative pain scores and nausea and vomiting within 24 h post-surgery were similar between the groups.But this study was only a preliminary study and needed to confirm in a larger, more robust trial.

Applying Opioid Free Anesthesia (Ofa) In Combination with Enhanced Recovery Anesthesia (Eras) In Bariatric-Metabolic Surgery: Evaluation at One Year Follow-Up with A Propensity Score

Since its introduction, laparoscopic bariatric metabolic surgery (BMS) has witnessed a consistant decrease in complications. Recently, enhanced recovery after surgery (ERAS) and opioid free (OFA) protocols have been developed separately to further improve outcomes. To assess the surgical outcomes after ERAS in combination with OFA (ERAS+OFA) in BMS. High volume bariatric metabolic center in Belgium. A retrospective observational study comparing by propensity score matching the outcomes of our center (ERAS+OFA) with the outcomes of an Italian center of excellence adhering to opioid sparing, but not opioid free ERAS (ERAS-OFA). Primary endpoints were: length of hospital stay, number of readmissions and complications including leaks and bleedings. Secondary endpoints were: the number and severity of complications as evaluated by the Clavien-Dindo score. Over a 12-month period, 341 consecutive patients treated according to ERAS+OFA in our center, were compared to 109 according to ERAS-OFA in the Italian center. Propensity matching resulted in comparable groups. Primary and secondary endpoints showed no significant difference between the 2 groups. Our study shows no statistically significant difference in BMS outcomes between ERAS+OFA compared to ERAS- OFA

Opioid-free anesthesia. Review of the technique and application in a case of a patient addicted to opiates.

INTRODUCCIÓN: Los opiáceos tienen efectos indeseables conocidos: náuseas, vómitos, sedación, íleo, depresión respiratoria, hiperalgesia, tolerancia, dolor crónico postoperatorio, adicción… La anestesia libre de opiáceos se basa en utilizar Ketamina, Dexmedetomidina, Lidocaína y otros fármacos coadyuvantes como AINES, corticoides, magnesio, hipotensores, junto con bloqueos regionales manejados con anestésicos locales, para conseguir una anestesia multimodal que sustituya en lo posible a los opiáceos. MÉTODO: Presentamos un caso de un paciente adicto crónico a opiáceos, que fue sometido a una laparotomía para amputación abdómino-perineal. Se colocó inicialmente un catéter epidural lumbar por el que se administró Levobupivacaína 0,25% en bolos, durante el período intraoperatorio. Además, el paciente fue manejado exitosamente con el protocolo que describimos en el artículo, utilizando una mezcla de fármacos como analgesia preemptiva, antes de la incisión quirúrgica, con objeto de prevenir la sensibilización al dolor del SNC; consta de AINES, Dexametasona y sulfato magnésico. Posteriormente se administró durante la inducción y mantenimiento anestésico, una mezcla de Lidocaína, Dexmedetomidina y Ketamina, a dosis bajas, junto con las dosis habituales de Propofol y relajación con Rocuronio, RESULTADO: La OFA permitió un adecuado manejo anestésico, con estabilidad hemodinámica óptima y ningún efecto secundario reseñable. CONCLUSIÓN: La OFA es una alternativa muy adecuada en el manejo anestésico de pacientes adictos a opiáceos, consiguiéndose excelentes resultados. Se requiere una amplia familiarización del anestesiólogo con la farmacología de las diversas fórmulas empleadas, así como su protocolización. PALABRAS CLAVE: opioid- free anaesthesia, OFA, analgesia, surgery, adverse effect, pain, opioid disorder.

Ketodex versus opioid based anesthesia in cleft palate

Background &amp; objective: Cleft palate is a congenital anomaly of the palate of the infants, and it may or may not be associated with cleft lip. The only remedy is surgical repair under general anesthesia. Postoperative pain relief in cleft palate repair surgery is very important to keep the infant or child calm and pain-free. It can only be achieved by use of analgesic drugs. We compared ketodex - a combination of ketamine and dexmedetomidine, versus opioid based anesthesia in cleft palate surgery as regards postoperative respiratory depression, need for oxygenation, and the emergence agitation. Methodology: Fifty children, aged 6 months to 5 y, undergoing cleft palate surgery under general anesthesia, were randomly assigned to either ketodex group (Group KD) or opioids group (Group OP). Group KD received ketamine 1mg/kg loading dose followed by infusion @ 0.1 mg/kg/h, and dexmedetomidine loading dose 1 µg/kg followed by infusion @ 0.2 µg/kg/h], isoflurane anesthesia. Group OP received fentanyl in a loading dose of 2 µg/kg followed by infusion @ 0.5 µg/kg/h, followed by isoflurane anesthesia. Heart rate, mean blood pressure, emergence agitation, extubation time, FLACC score for pain, surgeons’ satisfaction, and the adverse effects were noted. Results: Emergence agitation score was significantly lower in Group KD compared to Group OP. FLACC score showed insignificant difference between the two groups. There was no need for opioid administration in the PACU. Three patients in Group OP desaturated and needed oxygen supply. Incidence of vomiting was significantly higher in Group OP compared to Group KD (P = 0.022). Conclusion: Ketodex used in opioid free anesthesia for cleft palate repair surgery in children provides adequate pain relief without respiratory depression, and is a good alternative of routine opioid based general anesthesia. Key words: Ketamine; Dexmedetomidine; Opioids; Anesthesia; Recovery; Cleft Palate Surgery; Pediatrics Citation: Mohamed MM, Abdelraof AF, Noser MA. Ketodex versus opioid based anesthesia in cleft palate. Anaesth. pain intensive care 2024;28(1):74-80; DOI: 10.35975/apic.v28i1.2239 Received: May 31, 2023; Reviewed: June 06, 2023; Accepted: January 02, 2024

Opioid-free anaesthesia reduces postoperative nausea and vomiting after thoracoscopic lung resection: a randomised controlled trial

BackgroundIntraoperative opioid use has a positive relationship with postoperative nausea and vomiting (PONV), and opioid-free anaesthesia (OFA) may reduce PONV. We investigated whether OFA compared with opioid-based anaesthesia would reduce PONV during the first 2 postoperative days among patients undergoing thoracoscopic lung resection. MethodsIn this randomised controlled trial, 120 adult patients were randomly assigned (1:1, stratified by sex) to receive either OFA with esketamine, dexmedetomidine, and sevoflurane, or opioid-based anaesthesia with sufentanil and sevoflurane. A surgical pleth index (SPI) of 20–50 was applied for intraoperative analgesia provision. All patients received PONV prophylaxis (dexamethasone and ondansetron) and multimodal analgesia (flurbiprofen axetil, ropivacaine wound infiltration, and patient-controlled sufentanil). The primary outcome was the occurrence of PONV during the first 48 h after surgery. ResultsThe median age was 53 yr old and 66.7% were female. Compared with opioid-based anaesthesia, OFA significantly reduced the incidence of PONV (15% vs 31.7%; odds ratio [OR]=0.38, 95% confidence interval [CI], 0.16–0.91; number needed to treat, 6; P=0.031). Secondary and safety outcomes were comparable between groups, except that OFA led to a lower rate of vomiting (OR=0.23, 95% CI, 0.08–0.77) and a longer length of PACU stay (median difference=15.5 min, 95% CI, 10–20 min). The effects of OFA on PONV did not differ in the prespecified subgroups of sex, smoking status, and PONV risk scores. ConclusionsIn the context of PONV prophylaxis and multimodal analgesia, SPI-guided OFA administration halved the incidence of PONV after thoracoscopic lung resection, although it was associated with a longer stay in the PACU. Clinical trial registrationChinese Clinical Trial Registry (ChiCTR2200059710).

TEDOFA Trial Study Protocol: A Prospective Double-Blind, Randomized, Controlled Clinical Trial Comparing Opioid-Free versus Opioid Anesthesia on the Quality of Postoperative Recovery and Chronic Pain in Patients Receiving Thoracoscopic Surgery.

Seeking effective multimodal analgesia and anesthetic regimen is the basis for the success of ERAS. Opioid-free anesthesia (OFA) is a multimodal anesthesia associating hypnotics, N-methyl-D-aspartate (NMDA) antagonists, local anesthetics, anti-inflammatory drugs and α-2 agonists. Although previous studies have confirmed that OFA is safe and feasible for VATS surgery, there is great heterogeneity in how to select and combine anti-harm drugs to replace opioids. We hypothesized that the reduced opioid use during and after surgery allowed by OFA compared with standard of care will be associated with a reduction of postoperative opioid-related adverse events and an improvement in the quality of rehabilitation of patients after partial VATS lung resection. The TEDOFA Study is a prospective double-blind, randomized, controlled clinical trial with a concealed allocation of patients scheduled to undergo elective partial VATS pneumonectomy 1:1 to receive either a standard anesthesia protocol or an OFA. A total of 146 patients were recruited in the study. Primary endpoint was the 15-item recovery quality scale (QoR-15) at 24 hours after surgery. This trial has been approved by the Institutional Review Board of Beijing Friendship Hospital of China Capital University. The TEDOFA trial study protocol was approved on 27 February 2023. The trial started recruiting patients after registered on the Chinese Clinical Trial Registry. ChiCTR2300069210; Pre-results.

Perioperative Regional Anesthesia Pain Outcomes in Children: A Retrospective Study of 3160 Regional Anesthetics in Routine Practice.

Randomized controlled trials indicate regional anesthesia (RA) improves postoperative outcomes with reduced pain and opioid consumption. Therefore, we hypothesized children who received RA, regardless of technique, would have reduced pain/opioid use in routine practice. Using a retrospective cohort, we assessed the association of RA with perioperative outcomes in everyday practice at our academic pediatric hospital. Patients 18 years or below undergoing orthopedic, urologic, or general surgeries with and without RA from May 2014 to September 2021 were categorized as single shot, catheter based, or no block. Outcomes included intraoperative opioid exposure and dose, preincision anesthesia time, postanesthesia care unit (PACU) opioid exposure and dose, PACU antiemetic/antipruritic administration, PACU/inpatient pain scores, PACU/inpatient lengths of stay, and cumulative opioid exposure. Regression models estimated the adjusted association of RA with outcomes, controlling for multiple variables. A total of 11,292 procedures with 3160 RAs were included. Compared with no-block group, single-shot and catheter-based blocks were associated with opioid-free intraoperative anesthesia and opioid-free PACU stays. Post-PACU (ie, while inpatient), single-shot blocks were not associated with improved pain scores or reduced opioid use. Catheter-based blocks were associated with reduced PACU and inpatient opioid use until 24 hours postop, no difference in opioid use from 24 to 36 hours, and a higher probability of use from 36 to 72 hours. RA was not associated with reduced cumulative opioid consumption. Despite adjustment for confounders, the association of RA with pediatric pain/opioid use outcomes was mixed. Further investigation is necessary to maximize the benefits of RA.

Low opioid and opioid-free anesthesia - a review of current data

Introduction: Opioids are one of the most frequently used drugs during anesthesia. Due to the side effects anesthesiologists try to limit their number during anesthesia. They use low-opioid and opioid-free anesthesia. &#x0D; Purpose: The purpose of this work is to present the current state of knowledge and recent reports on low-opioid and non-opioid anesthesia and their use. &#x0D; Materials and Methods: The search was conducted using PubMed and GoogleScholar databases. Articles were searched in English using the following keywords: "low-opioid anesthesia," "non-opioid anesthesia," "OFA," "LOA" &#x0D; Key words: "low-opioid anesthesia", "non-opioid anesthesia", "OFA", "LOA", "opioids". &#x0D; Conclusion: low-opioid anesthesia techniques are being used more and more frequently and reduce the incidence of opioid side effects: respiratory depression, postoperative nausea and vomiting. This helps ensure greater patient safety and shortens the postoperative recovery period.

Intravenous infusion of lidocaine as a component of opioid-free anesthesia in thoracic surgery: prospective randomized single-center observational study

BACKGROUND: The possibility of reducing doses of narcotic analgesics during the perioperative period is widely discussed in modern scientific literature. This direction is called opioid-free anesthesia and is used in abdominal surgery, oncology, gynecology, and other areas. Publications on the use of opioid-free anesthesia in thoracic surgery are scarce.&#x0D; OBJECTIVE: To evaluate the analgesic effectiveness of intravenous lidocaine infusion as a component of anesthesia in thoracic surgery.&#x0D; MATERIALS AND METHODS: Ninety patients who underwent open lobectomy or pneumonectomy were examined. Depending on the analgesic component, patients were divided into three groups: group 1 (n=30) received intravenous infusion of lidocaine, group 2 (n=30) received epidural block, and group 3 (n=30) had fentanyl infusion. Blood pressure, heart rate, cortisol, and blood serum glycemia levels were measured. The intensity of postoperative pain syndrome and the need for promedol, tramadol, and sanitation fibrobronchoscopy were assessed. Arterial hypotension and frequency of postoperative nausea and vomiting were recorded. The length of stay of the patients in the intensive care unit and hospital was recorded.&#x0D; RESULTS: Cortisol levels did not differ between groups (p=0.26). The glucose level in the epidural block group was significantly lower than that in other groups (p=0.011). A significant increase in mean blood pressure and heart rate was observed in the opioid analgesia group (p 0.001). The lowest severity of pain 6 h after surgery was observed in the epidural blockade and lidocaine groups (p 0.001). Perioperative hypotension was more common in the epidural analgesia group (p=0.045). The incidence of postoperative nausea and vomiting was higher in the opioid anesthesia group (p=0.004). In the fentanyl infusion group, sanitary fibrobronchoscopy was more often required to eliminate atelectasis (p=0.039). The number of bed days spent in the ICU was significantly higher in the opioid analgesic group (p=0.002); however, no significant differences were noted between the groups regarding the number of days spent in the hospital (p=0.228).&#x0D; CONCLUSION: Opioid-free anesthesia based on intravenous lidocaine infusion, as a component of anesthetic management in thoracic surgery, provides sufficient perioperative stability of hemodynamic and neuroendocrine status, has a pronounced analgesic effect, with less opioid consumption on the first day after surgery, and helps reduce the length of stay in the intensive care unit and hospital.

Opioid-free anaesthesia.

Adverse effects of perioperative opioids have led to the pursuit of 'opioid-free anaesthesia'. While early studies have shown that effective analgesia can be achieved without using opioids, with some reduction in unwanted effects, further research is needed to elucidate which patients may benefit most and how.

Application of opioid-free general anesthesia in laparoscopy: a meta-analysis of randomized controlled studies

Applying opioid-free general anesthesia (OFGA) in laparoscopy was controversial. A systematic review and meta-analysis were conducted to investigate the efficacy and safety of employing OFGA in laparoscopy. Relevant clinical trials to include in this systematic review and meta-analysis were scrutinized through electronic databases such as Embase, PubMed, Cochrane Library and Web of Science. The quality of selected randomized controlled trials (RCTs) was assessed by Cochrane Collaboration’s bias risk assessment tool. The meta-analysis was conducted on Review Manager 5.3. The quality of evidence was assessed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The analysis in this study included 14 RCTs involving 1042 patients. No notable variation examined in 24-hour postoperative pain score between the opioid-based and OFGA groups (mean difference = −0.43, 95% confidence interval (−1.08, 0.22); p = 0.19). However, OFGA application reduced the postoperative analgesic needs and the incidence of postoperative nausea and vomiting. The meta-analysis and systematic review findings indicated that OFGA could be effectively and safely used in laparoscopy.

Assessment of feasibility of opioid-free anesthesia combined with preoperative thoracic paravertebral block and postoperative intravenous patient-controlled analgesia oxycodone with non-opioid analgesics in the perioperative anesthetic management for video-assisted thoracic surgery.

This study, conducted between December 2015 and March 2018 at a single university hospital, explored the feasibility and safety of opioid-free anesthesia combined with preoperative thoracic paravertebral block (ThPVB) for patients undergoing elective video-assisted thoracoscopic surgery (VATS). The aim was to assess the impact of this approach on postoperative pain levels and opioid consumption. Sixty-four patients scheduled for elective VATS were randomly assigned to either the intervention group, receiving opioid-free anesthesia with ThPVB, or the control group, managed with standard general anesthesia. Postoperatively, both groups received oxycodone patient-controlled analgesia along with non-opioid analgesics. Pain intensity was measured using the Numeric Pain Rating Scale (NRS) and Prince Henry Hospital Pain Score (PHHPS). The total dose of postoperative oxycodone and the occurrence of opioid-related adverse events were recorded during the 24-hour follow-up period. Patients in the intervention group showed significantly lower pain levels at 20 and 24 hours post-procedure ( P = 0.015, P = 0.021, respectively) compared to the control group. Notably, oxycodone consumption at 24 hours was significantly higher in the control group ( p < 0.0001). No serious adverse events were observed during the study period. This study demonstrates the feasibility and safety of opioid-free anesthesia combined with ThPVB for elective VATS. The approach significantly reduces postoperative pain and the need for opioids, supporting its potential as an effective and balanced perioperative anesthetic strategy.

Acute and Chronic Pain Management of the Urologic Patient

Objectives: Here, we review opioid-sparing or opioid-free anesthesia and pain management for urologic procedures and pathologies–urological pain syndromes, kidney stone pain management, development of post-surgical pain syndromes, and prevention. We explore acute management of perioperative pain during and after urologic procedures; additionally, we review the pathophysiology of various urologic pain syndromes along with a variety of interventions, including pharmacologic management, nerve blocks, neurolysis, and neuromodulatory therapies in hopes of educating providers who treat the urologic patient. Methods: Relevant literature on various topics related to acute and chronic urologic pain was reviewed and incorporated into this comprehensive overview. Relevant clinical treatments and treatment guidelines for managing pain related to various urological conditions and syndromes are discussed, compared, and contrasted and conclusions are drawn. Results and Discussion: Urological pathologies, procedures, pain syndromes and their pharmacologic and interventional pain management strategies are discussed. Conclusion: Acute and chronic pain remain essential components of postoperative morbidity, both in the urologic patient and otherwise. The opioid epidemic has further complicated perioperative management, but effective pain control is vital to improving patient outcomes. Close collaboration between urologists, anesthesiologists, and pain specialists is critical in improving patient care.

Opioid-Free Anaesthesia During Prolonged Orthotopic Urinary Bladder Diversion Surgery: A Prospective Randomized Comparative Study

Opioid-Free Anaesthesia During Prolonged Orthotopic Urinary Bladder Diversion Surgery: A Prospective Randomized Comparative Study

Comparing Different Modalities of Opioid Free Anesthesia for Laparoscopic Cholecystectomy

Comparing Different Modalities of Opioid Free Anesthesia for Laparoscopic Cholecystectomy

Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy: A Randomized Controlled Trial [Letter

Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy: A Randomized Controlled Trial [Letter

Effects of opioid-free anaesthesia on postoperative nausea and vomiting in patients undergoing video-assisted thoracoscopic surgery (OFA-PONV trial): study protocol for a randomised controlled trial

BackgroundPostoperative nausea and vomiting (PONV) is a common complication after general anaesthesia and is associated with morbidity and prolonged length of stay. Growing evidence suggest that opioid-free general anaesthesia (OFA) may reduce PONV in various surgical settings. We aim to evaluate the efficacy of OFA on the incidence of PONV compared with opioid-based anaesthesia among adults undergoing thoracoscopic surgery.MethodsThis is a prospective, single-centre, randomised controlled trial comparing OFA and opioid-based anaesthesia for thoracoscopic surgery. A total of 168 adults will be randomised with a 1:1 ratio to receive either opioid-free anaesthesia or opioid-based anaesthesia. The primary outcome will be the incidence of PONV within 24 h after operation. The secondary outcomes will include the severity of PONV, quality of recovery, pain at rest, 6-min walking test, and health-related quality of life after operation.DiscussionThe benefit-risk of OFA for patients after operation is contradictory in previous studies, so further study is required. This trial will focus on the effect of OFA on the incidence of PONV in patients undergoing thoracoscopic surgery. This trial adopts uniformed PONV and perioperative pain management, standardised randomised and blind, clear-cut inclusion and exclusion criteria, and standardised scales to assess the severity of PONV after surgery, the quality of postoperative recovery, and the health status at 6 months. The findings of this study will help to provide references to promote early recovery of patients after lung surgery.Trial registrationClinicalTrials.gov NCT05411159. Registered on 9 June 2022.