Do we feel pain during anesthesia? A critical review on surgery-evoked circulatory changes and pain perception

Cividjian, Andrei; Petitjeans, Fabrice; Liu, N.; Ghignone, M.; Kock, Marc De; Quintin, Luc

doi:10.1016/j.bpa.2017.05.001

Cited by 40 publications

(37 citation statements)

References 103 publications

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“…Yet one important question remains: what is the analgesic/anaesthetic effect of OFA during surgery [26]? OFA is an anaesthesia strategy that replaces opioids (balanced general anesthesia) with nonopioid drugs (multimodal general anesthesia).…”

Section: Discussionmentioning

confidence: 99%

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

Guinot

Spitz

Berthoud

et al. 2019

Preprint

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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 hours after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). Results: 110 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.

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Section: Discussionmentioning

confidence: 99%

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

Guinot

Spitz

Berthoud

et al. 2019

Preprint

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“…It may also permit the anaesthetist to predict postoperative pain permitting a logical approach to the administration of intra‐operative analgesia. In particular, it may allow logical administration of non‐opioids , confirming/quantifying the benefit of the analgesic technique including OFA. Another area is that it may enable the quality of epidural or regional blockade to be assessed before the end of surgery, and whether or not the analgesic regimen used is likely to be providing adequate analgesia, avoiding over‐ or underdosing of analgesics and the problems associated with both.…”

Section: Nociceptionmentioning

confidence: 97%

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

Fawcett

Jones

2018

Anaesthesia

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“…Looking at the physiology, various mediators are involved in nociception pathways: serotonin, norepinephrine, enkephalin, peptides…etc. Anti-nociception can then be obtained by interfering with various neuromediators not only by interfering with enkephalins with opioids [4]. Then, opioids are not indispensable essential for general anesthesia [3].…”

Section: Why Do We Use Intraoperative Opioids?mentioning

confidence: 99%

“…Then, opioids are not indispensable essential for general anesthesia [3]. However, we are currently lacking accurate and validated monitoring to measure of intra-operative nociception [4].…”

Section: Why Do We Use Intraoperative Opioids?mentioning

confidence: 99%

Opioid-free anesthesia

Beloeil

2019

Best Practice & Research Clinical Anaesthesiology

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Opioid Free Anesthesia (OFA) is emerging as a new stimulating research perspective. The rationale to propose OFA is based on the aim to avoid the negative impact of intraoperative opioid on patient's postoperative outcomes and also on the physiology of pathways involved in intraoperative nociception. It is based on the concept of multimodal anesthesia. OFA has been shown to be feasible but the literature is still scarce on the clinically meaningful benefits for patients as well as on the side effects and / or complications that might be associated with it. This review focused first on the physiology of nociception, the reasons for using or not opioids during anesthesia, and then on the literature reporting evidence-based proofs of benefits / risks associated with OFA.

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Do we feel pain during anesthesia? A critical review on surgery-evoked circulatory changes and pain perception

Cited by 40 publications

References 103 publications

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 retrospective matched case-control study

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

Opioid-free anesthesia

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