Bespoke intra‐operative anaesthesia – the end of the formulaic approach?

Fawcett, William; Jones, Christopher

doi:10.1111/anae.14253

Cited by 21 publications

(17 citation statements)

References 36 publications

(33 reference statements)

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“…Opioid administration is not without concern and is associated with many side-effects such as constipation, urinary retention, respiratory depression and postoperative nausea and vomiting [9]. This last-named outcome in particular is responsible for delayed patient recovery, prolonged patient stay in the recovery area, delayed hospital discharge and unanticipated admission to hospital, all of which increase health service costs [10].…”

Section: According To the International Association For The Study Ofmentioning

confidence: 99%

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

et al. 2019

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Efficacité analgésique d'une anesthésie avec opioïdes versus sans opioïdes : une revue systématique de la littérature avec méta-analyses [Analgesic impact of intra-operative opioids versus opioid free anesthesia: a systematic review and meta-analysis] Les opioïdes sont administrés durant l'intervention afin de contrôler la réponse sympathique à un stimulus chirurgical, mais aussi pour soulager la douleur postopératoire. Récemment, l'utilisation des opioïdes durant la chirurgie a été remise en question en raison de l'absence probable de bénéfice dans la phase postopératoire immédiat, mais aussi en raison des effets secondaires, tels que les nausées et vomissements postopératoires. Le but de cette méta-analyse est d'investiguer si l'utilisation d'opioïde intraopératoire comparée à une stratégie sans opioïde permet de diminuer les douleurs postopératoires sans augmenter le taux de nausées et vomissements postopératoires. Nous avons inclus des essais cliniques randomisés et contrôlés effectués chez des patients adultes pour tout type de chirurgie qui ont étudié l'efficacité analgésique postopératoire d'une administration intraopératoire d'opioïde avec soit l'administration d'un placebo, soit l'absence d'administration. L'analyse des 23 études identifiées avec plus de 1300 patients inclus a démontré que les scores de douleurs au repos (échelle de 0 à 10, 0 étant aucune douleur et 10 la pire douleur imaginable) à 2h postopératoire étaient équivalents dans les deux groupes, avec une différence moyenne (IC 95%) de 0,2 point (-0,2 à 0,5), p=0,38. Les taux de nausées et vomissements postopératoires étaient de 24% dans le groupe avec opioïde et 19% dans le groupe sans ce qui représente un risque relatif (IC 95%) de 0,77 (0,61 à 0,97), p=0,03. En conclusion, l'utilisation d'opioïde intraopératoire ne diminue pas les douleurs postopératoires, mais est associée à une augmentation des nausées et vomissements postopératoire.

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Section: According To the International Association For The Study Ofmentioning

confidence: 99%

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

et al. 2019

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“…The use of opioid analgesics has become widespread with the development of new opioid agents. Their use is based on their antinociceptive effects, the control of the autonomic nervous system (ANS) responses to surgical stress, and their induced hypnotic reduction [2]. However, the principle underlying the administration of opioids during anaesthesia has only recently been called into question.…”

Section: Introductionmentioning

confidence: 99%

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

et al. 2019

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Background No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. Methods After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). Results One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6–34) vs 5 mg (2–18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66–115) vs 77 mmol/l (IQR: 69–95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1–5) vs 5 (3–6) hours, p = 0.001 and 2 (1–3) vs 3 (2–5) days, p = 0.037). Conclusion The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. Trial registration This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.

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“…On inclusion, OFA and OA groups did not differ significantly in terms of demographic and surgical data. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) mg vs 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) mg, p=0.001). Analgesic rescue did not differ between the two groups.…”

Section: Introductionmentioning

confidence: 91%

“…The use of opioid analgesics has become widespread with the development of administration systems based on "target concentration", and the development of new opioid agents [1]. However, the principle underlying the administration of opioids during anaesthesia has never been called into question [2]. The concept of opioid free anaesthesia (OFA) is based on the fact that in an anesthetised patient a sympathetic reaction marked by hemodynamic changes does not systematically reflect a painful phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a case-control study

Guinot

Spitz

Berthoud

et al. 2019

Preprint

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Background No study has demonstrated feasibility and improvement of opioid free anaesthesia in cardiac surgery. The objective of the present study was to evaluate the effect of opioid-free anaesthesia (OFA) on post-operative morphine consumption and the post-operative course. Methods We performed a retrospective matched cohort study (1:1) in cardiac surgery with cardiopulmonary bypass. Patients were divided into two groups: OFA or opioid anaesthesia (OA). The main outcome was the cumulated total morphine consumption during the 48 post-operative hours. The secondary outcomes included rescue analgesics, a major adverse event composite endpoint, and the length of stay (LOS) in the ICU and in hospital. Results 110 were matched (OFA: n=55; OA: n=55). On inclusion, OFA and OA groups did not differ significantly in terms of demographic and surgical data. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) mg vs 5 (2-18) mg, p=0.001). Analgesic rescue did not differ between the two groups. The pain score during the first 48 post-operative hours did not differ between the two groups. Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p=0.021) in relation to lower use of non-invasive ventilation (15% vs 49%, p=0.032). The time to extubation and the ICU stays were shorter in the OFA group (3 (1-5) vs 5 (3-6) hours, p=0.001 and 2 (1-3) vs 3 (2-5) days, p=0.037). Conclusion The use of an OFA was associated with a decreased consumption of morphine and shorter ICU stays. Further randomized studies are needed to confirm these results.

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Bespoke intra‐operative anaesthesia – the end of the formulaic approach?

Cited by 21 publications

References 36 publications

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a case-control study

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