Opioid-free anesthesia

Beloeil, Hélène

doi:10.1016/j.bpa.2019.09.002

Cited by 97 publications

(79 citation statements)

References 51 publications

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“…However, liberal use of opioids has several limits (hyperalgesia, gastrointestinal alterations, prolonged mechanical ventilation, respiratory depression, etc). 1 Central neuraxial anesthesia techniques, such as thoracic epidural anesthesia block, have been studied but their use is limited in cardiac surgery due to their potential complications. Recently, bilateral erector spinae plane block (ESPB) seemed effective to decrease postoperative consumption of opioids after cardiac surgery and enhanced recovery after surgery.…”

mentioning

confidence: 99%

Bilateral Parasternal Block and Bilateral Erector Spinae Plane Block Reduce Opioid Consumption in During Cardiac Surgery

Bousquet

Labaste

Gobin

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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mentioning

confidence: 99%

Bilateral Parasternal Block and Bilateral Erector Spinae Plane Block Reduce Opioid Consumption in During Cardiac Surgery

Bousquet

Labaste

Gobin

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Останніми роками серед лікарів-анестезіологів в усьому світі все більшу популярність завойовує концепція безопіатної анестезії. Ця ідея широко висвітлюється в наукових роботах останніх років і базується на тому, що зменшення використання опіатів під час оперативних втручань корелює з кращими результатами лікування [1,2,3,4,5].…”

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“…Так, окрім дозозалежних побічних ефектів, що впливають на періопераційний стан пацієнта і іноді є причинами подовженої післяопераційної реабілітації, опіати можуть викликати гіпералегзію, яка стає тригером гострих та хронічних больових синдромів. Окрім цього доведено негативний вплив опіатів на імунну систему, що особливо важливо при лікуванні інфекції чи онкологічної патології [1,6,7,8]. Однак найбільш вагомим фактором, що провокував та індукував розвиток безопіатної анестезії, була так звана «опіатна криза».…”

unclassified

“…Отже, «безопіатна анестезія» -це різновид мультимодальної анестезії, що ґрунтується на комбінації різних препаратів та технік. Найкращою доведеною технікою для зменшення споживання опіатів є реґіонарна анестезія [1,17]. Але в інтервенційній радіології ці техніки не знайшли широкого використання.…”

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“…Між тим, в інтервенційній кардіології з метою аналгоседації (АС) застосовуються внутрішньовенна аналгезія. З метою пригнічення симпатичної відповіді та зменшення використання опіоїдів в сучасній анестезіології використовують досить широкий перелік препаратів, серед яких слід вказати кетамін, клофелін, лідокаїн, магнія сульфат, НПЗП тощо [1,4,20,21].…”

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Opioid-Free Analgosedation during Coronary Artery Stenting

Dziuba¹,

Nedashkivskij²,

Chubko³

et al. 2020

Ukr. ž. med. bìol. sportu

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The widespread usage of opioids / opiates in anesthetic practice has highlighted a number of related problems. Therefore, in recent years, the concept of opiate-free anesthesia has been gaining popularity among anesthesiologists around the world. In this context, we are interested in lidocaine as a component of this anesthesia. The attention of anesthesiologists to lidocaine during analgesia is due to its analgesic, anti-inflammatory and antihyperalgesic properties. The basis of the analgesic effect of the drug is that it blocks sodium channels and depolarizes nociceptive peripheral neurons, simultaneously inhibits NMDA receptors, reduces the number of cytokine complexes circulating in the plasma, and dissociates the Gq protein. In general, these properties lead to a decrease in opiate consumption, an acceleration of rehabilitation, a decrease in episodes of nausea and vomiting, a reduction in hospital stay, and even has certain neuroprotective properties. The purpose of our work was to establish the main aspects of non-opiate anesthesia usage that was based on lidocaine during coronary stenting. Material and methods. We studied 60 patients with coronary artery disease who underwent stenting of the coronary arteries in a planned manner. The main diagnosis was exertional angina FC II-III. In terms of the duration of the surgery, it was 38.54±19.3 minutes, and the number of stents was 1.3±0.7. The patients were evenly divided into two study groups, depending on the prescribed drug regimen. The first group included patients who were sedated by slow intravenous administration of diazepam and fentanyl. In the group of non-opiate anesthesia, a lidocaine solution was the main component of analgesia. At the stages before the start of the surgery, during the main stage, namely, the stent placement, and after the end of the surgery, the parameters of hemodynamics, saturation, gas and electrolyte composition of blood, the level of glycemia and cortisol were assessed. Results and discussion. The main complaint of patients in the control group was drowsiness, which was noted by 36.7% of patients. We attribute this feature to the use of diazepam. However, drowsiness was also noted in 33.3% of the experimental group after surgery. This fact can be explained by the use of significant doses of propofol, which were needed to maintain hemodynamics at the appropriate level. Episodes of nausea and vomiting may occur during surgery, especially when using opiates with a high probability. The phenomena of nausea were observed in 13.4% of the 1st group, and in the 2nd group it occurred in 3.3% of cases. According to the recommendations, we administered 4 mg of ondasetron solution after which the nausea disappeared. In the second group, complaints related to the local anesthetic effects of lidocaine came to the fore. 63.3% complained of "crawling ants" or numbness in the hand, the same sensations in the cheek and numbness of the tongue – 33.3%. After the operation, the feeling of numbness in the hand persisted in 16.7%. It should be noted that these sensations did not cause significant discomfort and did not interfere with anesthesia. Conclusion. In the course of the work, we came to the conclusion that the usage of lidocaine at a dose of 1 mg / kg of the patient's body weight is safe for coronary artery stenting operations and, at the same time, there are no negative effects inherent in opiate based anesthesia. At the same time, the local anesthetic effects after using lidocaine do not worsen the course of the postoperative period

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Feasibility and effectiveness of opioid‐free anesthesia in cytoreductive surgery with or without heated intraperitoneal chemotherapy

Tejedor

Bijelić

Deiros

et al. 2022

Journal of Surgical Oncology

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Background: Opioid-free anesthesia (OFA) provides analgesia minimizing opioids. OFA has not been evaluated in cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy. We aim to evaluate OFA feasibility and effectiveness in CRS.Methods: Retrospective cohort study of adult patients (84) undergoing CRS in a tertiary center from May 2020 until June 2021. Predefined protocols for either opioid-based anesthesia (OBA) or OFA were followed.Results: OFA protocol patients (41) had better mean pain scores (1 ± 0.8 vs. 2 ± 1; p = 0.00) despite the avoidance of intravenous and epidural fentanyl intraoperatively (220 ± 104 and 194 ± 73 µg, respectively, in OBA vs. 0; p = 0.00). Postoperative epidural levobupivacaine was also lower in the OFA group (575 ± 192 vs. 706 ± 346 mg; p = 0.034) despite the lack of epidural fentanyl without difference in duration (4.3 ± 1.2 vs. 4 ± 1.2 days; p = 0.22). Morphine consumption was very low (4.1 ± 10 vs. 1.7 ± 5 mg; p = 0.16).Intraoperative hypertensive events and postoperative nausea and vomiting (PONV) were higher for OBA (43) (30.2% vs. 7.3%; p = 0.01% and 69.8% vs. 34.1%; p = 0.001, respectively). Postoperative epidural fentanyl was independently associated with PONV (p = 0.004). There was no difference in total complications or length of stay. Conclusion:OFA is feasible, safe, and offers optimal pain control while minimizing the use of opioids in CRS.

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Opioid-free anesthesia

Cited by 97 publications

References 51 publications

Bilateral Parasternal Block and Bilateral Erector Spinae Plane Block Reduce Opioid Consumption in During Cardiac Surgery

Bilateral Parasternal Block and Bilateral Erector Spinae Plane Block Reduce Opioid Consumption in During Cardiac Surgery

Opioid-Free Analgosedation during Coronary Artery Stenting

Feasibility and effectiveness of opioid‐free anesthesia in cytoreductive surgery with or without heated intraperitoneal chemotherapy

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