Opioid Anesthesia Research Articles

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.

Dexmedetomidine in anaesthesia for laparoscopic surgery for acute cholecystitis

Background. In laparoscopic cholecystectomy (LCE), general anesthesia has its own characteristics due to the creation of pneumoperitoneum, changes in body position and adsorption of insufflated gas, which causes the occurrence of perioperative complications and requires improvement of anesthesiology programs.
 Objective: to determine the efficacy and safety of combined low opioid anesthesia based on dexmedetomidine in complex anesthesia in patients undergoing laparoscopic surgery for acute cholecystitis.
 Materials and methods. In total, the study included 163 patients undergoing LCE under general anesthesia. All patients were divided into 3 groups according to the anesthetic care scheme. In Group 1 (n=56), low-opioid anesthesia (dexmedetomidine, lidocaine, fentanyl 1–2 μg/kg/h) and artificial ventilation were performed; Group 2 (n=52): propofol with fentanyl (4–6 μg/kg/h) and artificial ventilation. In Group 3 (n=55): anesthesia with sevoflurane in combination with fentanyl and artificial ventilation.
 Results. Hyperdynamic reactions were observed in Group 2 and Group 3 at the beginning of the operation: heart rates and BP values after induction, with intubation in the 3rd, 5th and 7th minute of pneumoperitoneum, were slightly higher in Group 2 and 3 than in Group 1. However, moderate bradycardia was observed in Group 1 more often – in 5 patients (8.92%) than in patients in Group 2 and Group 3 – 2 cases (3.84%) and 2 cases (3.64%), respectively. The total number of injected analgesics during LCE was: in Group 1 – 141.52±23.64 μg, in Group 2 – 426.92±39.41 μg, in Group 3 – 354.75±28.63 μg (p <0.01). Only one patient in Group 1 required ondansetron for the treatment of PONV compared to 5 and 4 in Group 2 and Group 3, respectively (p <0.05). None of the patients in all groups reported “feeling” intraoperative events or “awakening during surgery”.
 Conclusions. The use of dexmedetomidine with lidocaine infusion three times reduced the use of opioids in the intraoperative period and to refuse their use in the postoperative period. With the use of low-opioid anesthesia in the postoperative period, the frequency of hypertensive reactions and tachycardia did not increase, but in the postoperative period, these p

DEXMEDETOMIDINE IN PARAVERTEBRAL BLOCK FOR BREAST CANCER SURGERIES- A WAY TOWARDS OPIOID FREE ANAESTHESIA

Introduction:Breast cancer is one of the leading causes of cancer morbidity and mortality in women across the world. One concerning problem that affects breast cancer patients after surgery is pain. Regional anesthesia may reduce cancer propagation by attenuation of the surgical stress response, reduced opioid usage and by the direct protective action of local anaesthetics on cancer cells migration. Therefore regional anesthesia should be considered for all breast cancer surgeries. Aim:The present study was conducted to compare the efficacy of Dexmedetomidine and Fentanyl as an adjunct to 0.5% Ropivacaine in thoracic paravertebral block, along with general anesthesia, in modified radical mastectomy surgeries. Methods: A total of forty patients were included in the study. All patients received the paravertebral block at 3 levels from T2-T4 with 15 ml of drug solution. Perioperative vitals and any complications wererecorded. Postoperative pain was assessed using Numeric Rating Scale (NRS). Results: Statistics did not reveal any significant difference in the degree of intraoperative analgesia, postoperative pain, nausea and vomiting among the two study groups. Conclusion:Among the two drugs, dexmedetomidine offers better hemodynamic stability and hence can be used in place of fentanyl for opioid free anaesthesia management.

An overview of opioid usage and regional anesthesia for patients undergoing repair of anorectal malformation.

The recent opioid crisis in the USA compelled us to evaluate our practice of opioid use for postoperative pain management and the influence of regional anesthesia on opioid requirement in patients undergoing repair of anorectal malformations. A retrospective chart review was performed evaluating patients who underwent posterior sagittal anorectoplasty (PSARP) and posterior sagittal anorecto-vagino-urethroplasty (PSARVUP), with or without laparotomy, between January 2016 and March 2020. Morphine milligram equivalents per kilogram (MME/kg) were calculated. IRB approval was obtained for this study. A total of 105 surgical patients had either a PSARP (74 without laparotomy, 10 with laparotomy) or PSARVUP (13 without laparotomy, 8 with laparotomy). Regional anesthesia included epidurals, transversus abdominis plane block, caudal block or paravertebral catheters. Of the PSARP patients, 4 without laparotomy and 7 with laparotomy received regional anesthesia. For PSARVUP with laparotomy, 4/8 received regional. 44% of PSARP patients without laparotomy did not require opioids postoperatively. The MME/kg required exponentially increased for patients over the age of 5 who underwent PSARP. Regional anesthesia is a useful modality for pain control for PSARP/PSARVUP with laparotomy, decreasing the opioid usage, but it is unnecessary for the already low opioid requirements, in patients younger than 5years of age, without laparotomy.

Which idea is better with regard to immune response? Opioid anesthesia or opioid free anesthesia.

The stress of surgery is characterized by an inflammatory response with immune suppression resulting from many factors, including the type of surgery and the kind of anesthesia, linked with the drugs that are used and the underlying disease of the patient. The trauma of surgery triggers a cascade of reactions involving the immune response and nociception. As strong analgesics, opioids provide the analgesic component of general anesthesia with bi-directional effect on the immune system. Opioids influence almost all aspects of the immune response in regards to leukocytes, macrophages, mast cells, lymphocytes, and NK cells. The suppressive effect of opioids on the immune system is limiting their use, especially in patients with impaired immune response, so the possibility of using multimodal anesthesia without opioids, known as opioid-free anesthesia (OFA), is gaining more and more sympathizers. The idea of OFA is to eliminate opioid analgesia in the treatment of acute pain and to replace it with drugs from other groups that are assumed to have a comparable analgesic effect without affecting the immune system. Here, we present a review on the impact of anesthesia, with and without the use of opioids, on the immune response to surgical stress.

Impact of opioid-free anesthesia on complications after deep inferior epigastric perforator flap surgery: A retrospective cohort study

This study measured the number of complications after deep inferior epigastric perforator (DIEP) flap reconstruction performed under opioid-free anesthesia (OFA) combined with goal-directed fluid therapy or opioid anesthesia with liberal fluid therapy (OA). This retrospective cohort study consisted of 204 patients who underwent DIEP flap reconstruction at AZSint Jan Brugge between April 2014 and March 2019. Primary outcomes were complications, according to the Clavien-Dindo classification and the length of hospital stay (LOS). The secondary outcomes were flap failure, postoperative nausea and vomiting (PONV), postoperative pain, postoperative opioid consumption, and postoperative skin flap temperature. OFA included a combination of dexmedetomidine, lidocaine, and ketamine without any opioid administered pre- or intraoperatively. OA included a combination of sufentanil and remifentanil. OFA patients received strict goal-directed fluid therapy, whereas OA patients received liberal fluids to maintain perfusion pressure. All patients except 7 (TIVA with remifentanil) received inhalation anesthesia combined with an infusion of propofol. Of the 204 patients, 55 received OFA and 149 received OA. There were no differences in major complications, but fewer minor complications in the OFA group (17.9% vs. 51.4% and P<0.001). Flap failure occurred in three patients of the OA group. Six patients developed flap thrombosis (five OA patients and one OFA patient). OFA was associated with fewer postoperative opioids, shorter LOS, less PONV, and less pain. In patients without previous nausea, the PONV incidence was higher in the OA group than in the OFA group (12.7% vs. 43.6% and P<0.001). Patients with previous nausea more frequently required postoperative opioids and had a nausea rate of 60.87%.

Evaluation of Efficacy of Free Opioid Anesthesia for Laparoscopic Cholecystectomy: A Prospective, Randomized Double-blinded Study

Objectives: To evaluate efficacy and side effects of free opioid anesthesia for laparoscopic cholecystectomy. Methods: A prospective study was performed on 94 patients undergoing laparoscopic cholecystectomy in Military Hospital 103 from May 2018 to February 2019. These patients were randomly allocated into two groups: patients in FOA (free - opioid anesthesia) group were administered lidocaine (2 mg/kg before induction and 1.5 mg/kg/h for maintenance), magnesium (30 mg/kg before induction and 1.5 g infusion for maintenance) combined with Intravenous (IV) injection of ketamine (0.5 mg/kg), and ketorolac (30 mg); while patients in OA group (opioid anesthesia) were provided with IV fentanyl (5 mcg/kg for induction and 1.5 mcg/kg every 30 minutes for maintenance of anesthesia). Both groups received total intravenous anesthesia by propofol. The depth of anesthesia was monitored by the entropy module during surgery. Neuromuscular blockade was reversed by sugammadex 2 mg/kg at the end of surgery. The postoperative analgesia was delivered using IV fentanyl for 48 to 72 hours. Visual Analog Scale (VAS) score was measured 10 mins, 20 mins, 1 hour, 2 hours and 3 hours after surgery. Results: All patients had an excellent quality of anesthesia with RE (Respond Entropy), SE (State Entropy) always under 60 from induction to abdominal closure without intraoperative awareness and postoperative recall of the operation; 100% of the patients were extubated immediately after surgery. In the first three postoperative hours fentanyl consumption in Group FOA was significantly lower than in Group OA (31.91 ± 3.98 mcg versus 34.47 ± 7.17 mcg, p=0,035). In the OA group, the rate of intraoperative hypotension was higher compared to its counterpart. Despite the higher risk of hypersalivation, group FOA had a significantly lower incidence of nausea and vomiting. Conclusion: Free opioid anesthesia provided adequate sedation and amnesia and may be an alternative approach to opioid anesthesia for laparoscopic cholecystectomy. Patients under free opioid anesthesia experienced a lower incidence of intraoperative hypotension, lower rate of nausea, vomiting and lower demand for analgesia in the early postoperative period (0 - 3 h) compared to those receiving opioid anesthesia.

Do we really need opioids in anesthesia?

Since the 1990s, high-income countries have seen an exponential increase in opioid use, misuse, and overdose. This “opioid crisis”, or “opioid epidemic”, began in the USA, spread to Europe, and is now extending to Asia. Today, opioids are still rarely available in many low and middle-income countries. In Pakistan, for instance, the only available opioids are morphine, fentanyl, nalbuphine, and tramadol, and these too are available only in tertiary hospitals. Is there a relationship between opioid exposure during anesthesia and opioid-induced hyperalgesia, hospital readmission, opioid addiction, cancer recurrence, immune system impairment, higher risk of postoperative delirium, and cognitive dysfunction? Signs in the recent literature confirm some of these hypotheses, and reducing opioid use in anesthesia is becoming a necessity. The concept of “opioid-free anesthesia” has emerged over the years in the literature. Is opioid-free anesthesia the solution? Is it a real paradigm shift? Nevertheless, it is important to keep in mind that stress-induced postoperative pain negatively influences outcome. The use of opioids in the postoperative phase could be necessary, but they have to be titrated and reduced to the minimum needed. Opioid-free postoperative analgesia is a new debate in the literature.

Experience with intraoperative infiltration anesthesia during knee replacement

Intraoperative local infiltration anesthesia significantly reduces the need for opioid anesthesia in the postoperative period, accelerates early activation and rehabilitation due to adequate analgesia, and reduces postoperative blood loss due to vascular spasm in the wound during total knee replacement. Due to the quick adaptation of patients to the joint implant, it is possible to reduce the time spent by patients in hospitals, as well as reduce the cost of treatment.

Lidocaine Combined With Low Opioid Anesthesia and Analgesia in Patients With Primary Liver Cancer

Lidocaine Combined With Low Opioid Anesthesia and Analgesia in Patients With Primary Liver Cancer

Perioperative Pain Control in Bariatric Surgeries, a Systematic Review

Abstract Introduction Research on adequate postoperative pain management is a current trend in post-anesthetic and surgical areas. Patient satisfaction is a parameter of medical quality. High pain scores increase the incidence of post-operative morbidity and lead to delayed recovery, prolonged hospital stay and increased healthcare costs.1 Bariatric Surgeries are surgeries performed for morbid obese patient to reduce patient’s weight through several methods and because morbid obese patients are at higher risk of complications after surgery2, Pain control during bariatric surgery is a major challenge3. Opioids play an important role in anesthesia practice; however, related complications like; sedation, airway obstruction, and respiratory depression are of concern in morbid obese patients .Therefore, opioids should be used sparingly. And newly safe methods better to be used for better perioperative pain control in bariatric surgeries. Objective To cover the gab of knowledge regarding the evidence of the safest and most efficient method to control perioperative pain in bariatric surgeries by reviewing the literature about this evidence through comparative systematic review study. Methodology Systematic review study discussed the results of 30 studies found in the literature related to perioperative pain control in bariatric surgeries according to the inclusion and exclusion criteria . Results and Discussion 30 different studies were discussed about the different methods of anesthesia in bariatric surgeries 6 of them about Transverses abdominis plane. ‘TAP’ block, 5 about Local anesthesia, 4 about Dexmedetomidine, 3 about spinal morphine, 3 about multi modal analgesia, 2 about preoperative medication, 2 about patient controlled analgesia ‘PCA', 1 about continuous infusion catheter, 1 about ibuprofen, 1 about Pulmonary recruitment maneuver, 1 about Sugammadex and 1 about non opioid anesthesia). Results are recorded about the efficacy of each method through the outcome measures. Conclusion It's found that the most effective method is multi modal analgesia represented in preoperative ultra sound guided TAP block, intraoperative port- sites and intraperitoneal infiltration with local anesthesia then recovery by sugammadex followed by postoperative IVI acetaminophen and PCA. Using preoperative clonidine, ketamine, pregabalin, epidural analgesia and pulmonary recruitment maneuver at the end of the surgery are also with low complication. Continuous infusion catheter, IV Ibuprofen, combined Dexmedetomidine and Acetaminophene, preoperative port-site infiltration and post operative intraperitoneal local anesthetic have no evidence based efficacy right now and it needs further studies.

Abstract P6-13-05: Impact of olaparib versus chemotherapy on the use of strong pain medications in gBRCA-mutated HER2-negative metastatic breast cancer and associated patient reported outcomes

Abstract Background: Pain is among the most common and distressing symptoms in patients with cancer, frequently requiring treatment with strong pain medication (SPM). The use of SPM may be associated with an adverse health impact arising from SPM-mediated side effects and/or the underlying deterioration causing SPM use. Regardless of cause, delaying the need for or escalation in SPM use would be desirable. The primary aim of this post-hoc analysis was to assess the impact of olaparib on SPM use compared with chemotherapy treatment of physician’s choice (TPC) in patients with gBRCA-mutated HER2-negative metastatic breast cancer in the OlympiAD study (NCT02000622). Further exploratory analyses were performed to understand the association between SPM use and patient-reported outcomes (PRO). Methods: Data on the first use and dose increase in commonly prescribed SPMs, including opioid analgesics and anesthetics, were obtained from concomitant medication data routinely collected up to 30 days post-discontinuation of study drug in OlympiAD. The impact of study treatment on SPM use was assessed using the time from randomization to on-treatment initiation/dose increase of SPMs. The association between SPM use and PRO were assessed via a mixed-model for repeated measures analysis of EORTC QLQ-C30 data, routinely collected up to RECIST progression, with covariates for treatment, and pre- versus post-initiation or increase in SPMs. Differences in the association between SPMs and PRO, and randomized treatment were assessed via an interaction term. All analyses were performed on the full analysis set of the OlympiAD study. Results: 29.3% of olaparib patients and 30.9% of TPC patients had an on-treatment initiation/dose increase in SPMs during study follow-up. The hazard ratio of the time to on-treatment initiation/dose increase in SPMs comparing olaparib with TPC was 0.55 (95% confidence interval 0.33, 0.90; nominal P=0.0174); 77.2% in the olaparib arm and 66.2% in the TPC arm were event free at 6 months. The mean difference in PRO scores comparing post- versus pre-SPM periods across both study arms are presented in Table 1. For all but one of the EORTC scales, there was no statistical evidence of a difference in mean scores by SPM period according to randomized group. For social functioning, TPC patients experienced a -14.9 (-24.82, -5.07; P=0.0031) point change in the post- versus pre-SPM period, compared with 0.6 (-5.39, 4.22; P=0.8104) for olaparib. Table 1: Mean difference in EORTC QLQ-C30 scales (all randomized patients in OlympiAD)EORTC QLQ-C30 ScaleMean difference post vs pre-SPM (95% CIs; nominal P value)Global health status-3.7 (-8.73; 1.42; P=0.1576)Functioning (decrease equates to worsening)Physical-4.6 (-8.03; -1.08; P=0.0103)Role-7.6 (-13.25; -1.92; P=0.0088)Emotional-4.3 (-8.72; 0.14; P=0.0580)Cognitive-2.4 (-6.72; 2.01; P=0.2894)Social-7.8 (-13.28; -2.25; P=0.0059)Symptoms (increase equates to worsening)Fatigue3.9 (-1.17; 9.05; P=0.1306)Pain6.7 (1.25; 12.23; P=0.0163)Nausea/vomiting4.1 (0.56; 7.69; P=0.0233)Dyspnea4.3 (-1.28; 9.92; P=0.1300)Appetite loss6.3 (0.33; 12.36; P=0.0386)Insomnia2.2 (-3.96; 8.34; P=0.4848)Constipation4.5 (-0.54; 9.57; P=0.0796)Diarrhea-2.9 (-7.37; 1.49; P=0.1935)Financial difficulties5.7 (-0.23; 11.70; P=0.0597) Conclusions: Olaparib appears associated with a delay in the use of, or escalation in, SPM versus TPC. Across study arms, SPM use was associated with a decrement in EORTC QLQ-C30 pain score, as well as worsening in role, physical and social functioning, and symptoms of appetite loss, and nausea and vomiting. These results support the relevance of SPM as an indicator of deterioration in PRO. Further research on the impact of SPM on PRO in breast cancer is required. Citation Format: Chantal Merens, Wendy Bannister, Sven Bergner, Robert Hettle, Charles McCrea, Susan McCutcheon, Arnold Degboe. Impact of olaparib versus chemotherapy on the use of strong pain medications in gBRCA-mutated HER2-negative metastatic breast cancer and associated patient reported outcomes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-13-05.

Suggested, Less-Explored Agents for Opioid Free Anesthesia

Suggested, Less-Explored Agents for Opioid Free Anesthesia

Fentanyl - Based Cardiac Anesthesia Provides Higher Recovery Compared with Morphine in Elective CABG Surgery Patients

Background : High-dose opioid anesthesia during cardiac surgery has been the mainstay of cardiacanesthesia for decades due to its ability to preserve hemodynamic stability and attenuate hormonal andmetabolic response to surgical stress. The hypothesis of this study is that the use of fentanyl as part of abalanced anesthetic would lead to improved patient health status and recovery during the first 3 daysafter cardiac surgery with CPB compared with morphine. Quality of recovery was assessed using theQoR-40 questionnaire administered preoperatively and daily on postoperative days 1–3. Hemodynamicvariables, duration of tracheal intubation, organ morbidities, intensive care unit (ICU) and hospitallength of stay were evaluated. Methods: This comparative randomized double blind study was conducted in the department ofcardiothoracic vascular anaesthesia and critical care of Apollo Hospitals,Dhaka on 100 patientsundergoing elective CABG. Study period was (January-July), 2019. The study was approved by theinstitutional review board, and informed consent was obtained from all subjects. One hundred patientspresenting for elective CABG surgery, between the ages of 18 and 79, were enrolled in the study. Exclusioncriteria included (1) concurrent valvular surgery or the presence of valvular disease, (2) reoperativeprocedures, (3) unstable angina or elevated cardiac enzymes within 48 hours of surgery, (4) morphine orfentanyl allergy, (5) the need for an intra-aortic balloon pump or inotropic agents preoperatively, (6)psychiatric or central nervous system disturbances precluding completion of the QoR-40. Results: Compared with patients given morphine, those receiving fentanyl had higher global QoR-40scores on postoperative days 1 (174.8 vs 162.5, P 0.001), 2 (175 vs 166.1, P 0.001), and 3 (178.1 vs 167.3,P 0.001). Differences between the groups were observed in the QoR-40 dimensions of emotional state,physical comfort, and pain . Postoperative visual analog scale pain scores, use of pain medication in theICU and surgical ward, and postoperative febrile reactions were reduced significantly in the fentanylgroup . No differences between the groups were noted in duration of tracheal intubation,ICU and hospitallength of stay, or postoperativecomplications. Conclusion: Continuous intravenous infusions of fentanyl have been used to provide intraoperativeanalgesia also give good-to-excellent postoperative analgesia furthermore early extubation and the qualityof postoperative recovery in cardiac surgical patients can be enhanced when fentanyl is used as part of abalanced anesthetic. JBSA 2020; 33(1): 28-35

Opioid Free Anesthesia and Bariatric Surgery

Opioid Free Anesthesia and Bariatric Surgery

Opioid Free Anesthesia in ENT Surgery

Opioid Free Anesthesia in ENT Surgery

A Retrospective Analysis of the Safety and Efficacy of Opioid-free Anesthesia versus Opioid Anesthesia for General Cesarean Section.

IntroductionWhile uncommon for cesarean delivery, general anesthesia may be patient requested or necessary due to maternal contraindication. Traditionally, opioids are used as a part of the general anesthetic. Because of their associated complications, it is standard to limit opioid use and fetal narcotic exposure during cesarean delivery. We conducted a retrospective study to evaluate the feasibility of multi-modal opioid-free general anesthesia for cesarean delivery.MethodsElectronic medical records were obtained for patients receiving general anesthesia for cesarean delivery of live pregnancies through 2017 at our tertiary care facility. Post-operative pain was estimated using a 10-cm visual analogue scale and by calculating postoperative narcotic requirements in milligram morphine equivalents (MME) over three-time periods: during post-anesthesia recovery in the post-anesthesia care unit (PACU), the first 24 hrs after PACU discharge, and 24-48 hrs after PACU discharge. Apgar scores were also obtained to quantify neonatal effects of the general anesthetic.ResultsEight of 17 patients (47.06%) received opioid-free anesthesia (OFA), and nine of 17 patients (52.94%) received anesthesia with opioids (OA). No significant difference was found between groups in terms of postoperative mean Visual Analog Scale (VAS) pain score over each time period. Similarly, no significant difference was found between groups in terms of postoperative narcotics requirement at all study points. Apgar scores were not significantly different between the two groups.ConclusionThe OFA group displayed equivalent analgesia to the OA group in terms of self-reported VAS pain scores and postoperative MME. A larger prospective study is recommended to fully evaluate OFA for cesarean delivery.

Opioid Based Anaesthesia vs Opioid Free Anesthesia in Cleft Lip, Palate ,Alveolus Surgery.

Opioid Based Anaesthesia vs Opioid Free Anesthesia in Cleft Lip, Palate ,Alveolus Surgery.

The Effect of Opioid Free Anesthesia in Bariatric Surgeries

The Effect of Opioid Free Anesthesia in Bariatric Surgeries