Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Aguerreche, Clément; Cadier, Gaspard; Beurton, Antoine; Imbault, Julien; Leuillet, Sébastien; Rémy, Alain; Zaouter, Cédrick; Ouattara, Alexandre

doi:10.1186/s12871-021-01362-1

Cited by 14 publications

(15 citation statements)

References 57 publications

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“…17 Also, OFA has been shown to decrease postoperative opioid consumption in bariatric surgery, 18 gynecological procedures, 19 spine surgery, 11 and more recently in cardiac surgery. 20 In our study, there was no signi cant difference in the opioid consumption between the two groups in the PACU, however the OFA patients received signi cantly less morphine than the OBA patients in the rst 24 hours after surgery, although there was no signi cant difference in morphine consumption between both groups at 48 hours from surgery. Similar results for the morphine consumption during the rst 24 hours were reported by Grape et al 21 The mechanism by which dexmedetomidine provides this 24 hours long term analgesic effect, and possibly, longer pro-analgesic effect is still not established.…”

Section: Discussioncontrasting

confidence: 50%

Opioid Free Versus Opioid Based Anesthesia in Major Spine Surgery: A Prospective, Randomized, Controlled Clinical Trial

Barakat

Gholmieh

Nader

et al. 2023

Preprint

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Background: The aim of this study is to compare the intraoperative opioid free anesthesia approach to the conventional opioid based anesthesia in patients undergoing multilevel spinal fusion surgery, and its impact on postoperative pain, opioid consumption, and related side effects. Methods: Forty-eight patients undergoing elective major spine surgery were randomly allocated to two groups. The Opioid-Free Anesthesia (OFA) group received dexmedetomidine 0.5mcg/kg/hr and lidocaine 1mg/kg/hr as continuous intravenous (IV) infusion for 10 minutes before anesthesia induction, followed by dexmedetomidine 0.3 mcg/kg/hr and lidocaine 1.5mg/kg/hr as continuous IV infusion intraoperatively. The Opioid-Based Anesthesia (OBA) group received fentanyl 2mcg/kg during anesthesia induction and remifentanil 0.2-0.3 mcg/kg/min continuous IV infusion intraoperatively. All patients received ketamine 0.15mg/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg for anesthesia induction and ketamine 0.15 mg/kg/hr with sevoflurane for anesthesia maintenance. All patients received a Patient Controlled Analgesia (PCA) device set to deliver IV morphine ready for use directly after discharge from the Post Anesthesia Care Unit (PACU) for 48 hours after surgery. Postoperative pain was measured using Verbal Analogue Scale (VAS). Opioid side effects were documented when present. Results: The OFA group required less morphine consumption in the first 24 hours post-surgery (17.28 ± 12.25 mg versus 27.96 ± 19.75 mg, p < 0.05). The incidence of nausea and vomiting was significantly lower in the OFA group. There was no significant difference in the hemodynamic changes intraoperatively among the two groups. However, more patients in the OFA group required antihypertensive medications compared to patients in the OBA group (p< 0.05). In the PACU, OFA patients had a significantly longer stay than OBA patients (114.1± 49.33 min versus 89.96 ± 30.71 min, p<0.05), yet there was no significant difference in the morphine consumption. Conclusion: OFA can be an alternative to OBA in patients undergoing multilevel spine fusion surgery. OFA use resulted in reduced need for analgesics for the first 24 hours and less postoperative nausea and vomiting. Trial registration: The study was conducted after receiving approval from local Institutional Review Board, Lebanese American University, Institutional Review Board (LAU IRB) (LAUMCRH.HB1.11/01/2018): and was registered with ClinicalTrials.gov (registration number: NCT03417193) and posted on 31/01/2018.

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Section: Discussioncontrasting

confidence: 50%

Opioid Free Versus Opioid Based Anesthesia in Major Spine Surgery: A Prospective, Randomized, Controlled Clinical Trial

Barakat

Gholmieh

Nader

et al. 2023

Preprint

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“…Generally, low-dose IV lidocaine does not cause adverse effects and is considered a safe component of intraoperative analgesia. 23 OFA with dexmedetomidine and lidocaine has been successfully used in gastric, 24 , 25 hepatobiliary, 26–28 breast, 29 cardiac, 30 thoracic, 31 , 32 orthopedic, 33 , 34 and spine surgery 35 , 36 with a reduction in postoperative pain intensity and opioid consumption, and a lower rate of postoperative complications. Considering these studies and our results, OFA with dexmedetomidine and lidocaine could benefit the general population.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Choi¹,

Song²,

Oh³

et al. 2022

JPR

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Purpose Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy. Patients and Methods Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels. Results The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group ( p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group ( p = 0.002). Conclusion OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

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“…As a new agonist of the a2-adrenergic receptor, the nonopioid, dexmedetomidine, is characterized by its high selectivity and greater analgesic effects [ 6 , 7 ]. Dexmedetomidine-based OFA in cardiac surgery patients is feasible and could be associated with lower postoperative morphine consumption and better postoperative outcomes, reducing local anesthetic consumption, as well as producing fewer side effects [ 8 ]. Dexmedetomidine has been shown to protect numerous organs in recent studies (such as the heart, kidney, lung, intestine, liver, and nervous system).…”

Section: Introductionmentioning

confidence: 99%

Opioid-Free Labor Analgesia: Dexmedetomidine as an Adjuvant Combined with Ropivacaine

Gao

Wang

Zhang

et al. 2022

Journal of Healthcare Engineering

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Background. Side effects of the use of opioid analgesics during painless delivery are the main factors that affect rapid postpartum recovery. Opioid use can result in dangerous respiratory depression in the patient. Opioids can also disrupt the baby’s breathing and heart rate. The nonopioid analgesic dexmedetomidine, a new a2-adrenergic agonist, possesses higher selectivity, greater analgesic effects, and fewer side effects. Moreover, epidural administration of dexmedetomidine also reduces local anesthetic consumption. Objective. Our study aims to compare the analgesic effects as well as the side effects of ropivacaine with dexmedetomidine against sufentanyl as an epidural labor analgesia. Methods. This study is a randomized, double-blinded, controlled trial (registration no. ChiCTR2200055360) involving 120 primiparous (a woman who has given birth once), singleton pregnancy women who are greater than 38 weeks into gestation and have requested epidural labor analgesia. The participants were randomized to receive 0.1% ropivacaine with sufentanyl (0.4 μg/ml) or dexmedetomidine (0.4 μg/ml). The primary outcomes included Visual Analogue Score (VAS), duration of first epidural infusions, the requirement of additional PCEA bolus, and adverse reactions during labor analgesia. Results. Of the 120 subjects who consented, 91 parturient women (women in the condition of labor) had complete data for analysis. Demographics and VAS, as well as maternal and fetal outcomes, were similar between the groups. The duration of first epidural infusions in dexmedetomidine was significantly longer than sufentanyl (median value: 115 vs 68 min, P < 0.01); the parturient women who received dexmedetomidine and who required additional PCEA bolus were fewer in comparison to those who received sufentanyl (27.5% vs 49.0%, P < 0.05). Furthermore, the incidence of pruritus in the dexmedetomidine group was lower in comparison to the sufentanyl group (0% vs 11.8%, P < 0.05). Conclusions. Dexmedetomidine, a nonopioid, is superior to the opioid analgesic sufentanyl in providing a prolonged analgesic effect as an epidural during labor. It also reduces local anesthetic consumption and has fewer side effects. The trial is registered with ChiCTR2200055360.

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Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

Cited by 14 publications

References 57 publications

Opioid Free Versus Opioid Based Anesthesia in Major Spine Surgery: A Prospective, Randomized, Controlled Clinical Trial

Opioid Free Versus Opioid Based Anesthesia in Major Spine Surgery: A Prospective, Randomized, Controlled Clinical Trial

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Opioid-Free Labor Analgesia: Dexmedetomidine as an Adjuvant Combined with Ropivacaine

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