Opioid-free anaesthesia: The conundrum and the solutions

Gupta, Lalit; Agarwal, Jyotsna; Saxena, KirtiNath

doi:10.4103/ija.ija_256_22

Cited by 6 publications

(3 citation statements)

References 25 publications

(22 reference statements)

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“…Gupta et al . [ 18 ] discussed in their review article the effects of other non-opioid analgesic agents, including magnesium sulphate and dexamethasone, as OFA on enhanced recovery and to avoid the adverse effects of opioid use. Peng et al .…”

Section: Discussionmentioning

confidence: 99%

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

Kamel,

Fahmy,

Medhat

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: 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. Methods: 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. Results: 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). Conclusion: Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

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Section: Discussionmentioning

confidence: 99%

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

Kamel,

Fahmy,

Medhat

et al. 2024

Indian Journal of Anaesthesia

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“…The success of ERAS is mainly due to right combination of analgesia, with minimal post operative nausea, vomiting, early mobilization in postoperative period. 12 So opioid sparing strategies with usage of regional anaesthesia and multimodal pain management have been emphasized. Many patients with obesity, opioid addiction, elderly, major surgeries benefit with use of OFA.…”

Section: Discussionmentioning

confidence: 99%

Case series: Opioid free anaesthesia

J¹

2022

IJCA

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Opioid free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with anaesthetic. Opioid free analgesia similarly avoids opioids in the perioperative period. Opioids in perioperative period which is associated with various adverse effects and poor surgical outcomes. Opioids in perioperative period is associated with respiratory depression, impaired gastrointestinal function, postoperative nausea and vomiting (PONV), Urinary retention, delirium, and potential for opioid addiction. Now many non- opioid analgesics are currently available that have less side effects and lower potential for addiction. Replacing opioids with other analgesics will not only reduce opioid addiction but will also lead to better perioperative outcomes and enhanced patient recovery. Recently opioid sparing strategies have been emerged and non opioid based multimodel strategy is being used worldwide.

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“…[ 10 ] This clearly endorses the use of non-opioids in multi-modal post-operative pain management. [ 11 ] Nevertheless, the use of non-opioids in pain management is no longer novel and is now a favourite strategy of both researchers and clinicians. [ 12 ]…”

Section: Current Peri-operative Pain Practice Patternsmentioning

confidence: 99%