Opioid-free anesthesia for breast cancer surgery: An observational study

Tripathy, Swagata; Rath, Satyajit; Agrawal, S. S.; Rao, P. Rama; Panda, Aparajita; Mishra, Tushar Subhadarshan; Nayak, Smrutiranjan

doi:10.4103/joacp.joacp_143_17

Cited by 48 publications

(28 citation statements)

References 22 publications

(27 reference statements)

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“…Opioid-free anesthesia (OFA) is a new concept of analgesic therapy. OFA is fully in line with the concept of accelerated rehabilitation surgery (ERAS), using multimode anesthesia and pain management to significantly improve patient outcomes and reduce the incidence of postoperative adverse reactions and promote patient recovery [ 11 ]. As a result, the optimal labor analgesia not only provides adequate analgesia to parturients but also reduces opioid intake without causing adverse effects, allowing for rapid neonatal or maternal postpartum recovery.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…In this study, patients in the OFA group who received non-opioid PCA regimen (dexmedetomidine and ketorolac) combined with bilateral PVB received less rescue analgesics than patients who received dezocine and ketorolac for PCA and PVB at 24 or72 h after surgery, while VAS scores showed no difference between groups. Tripathy and colleagues [3] reported that non-opioid nerve blocks (dexmedetomidine, ropivacaine and lignocaine) resulted lower VAS scores at 24 h after surgery and lesser morbidity for modified radical mastectomy with axillary clearance. Abd-Eishafy et al reported that in patients who underwent elective video-assisted thoracic surgery, PVB with isobaric bupivacaine and dexmedetomidine (1 μg•kg −1 ) provided better pain relief during the early postoperative hours, and exerted a favorable effect on chronic postoperative pain [29].…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical studies have challenged the common practice of administering opioids during anesthesia, suggesting that opioid-free anesthesia (OFA) may effectively provide adequate antinociception while hopefully reducing opioid-related side effects [1][2][3][4][5]. However, these studies focused more on the effect of OFA on postoperative analgesia scores (visual analog scale, VAS), rescue analgesic consumption, and incidence of adverse reactions related to opioid analgesics.…”

Section: Introductionmentioning

confidence: 99%

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Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study

Wang

Zhao

et al. 2022

BMC Anesthesiol

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Background Few studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an effective analgesia-antinociception balance monitored by the / pain threshold index in laparoscopic radical colectomy. Methods We enrolled 102 patients undergoing laparoscopic radical colectomy with general anesthesia. Participants were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine (loading dose with 0.6 μg·kg−1 for 10 min and then 0.5 μg·kg−1·h−1 continuous infusion) and sevoflurane plus bilateral paravertebral blockade (0.2 μg·kg−1 dexmedetomidine and 0.5% ropivacaine 15 ml per side) or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and bilateral paravertebral blockade (0.5% ropivacaine 15 ml per side). The primary outcome variable was pain intensity during the operation, as assessed by the pain threshold index with the multifunction combination monitor HXD- I. Results were analyzed using repeated measures analysis of variance and Student’s t-test. The secondary outcomes were wavelet index, lactic levels, and blood glucose concentration during the operation. The visual analog scale (VAS), rescue analgesic consumption, and side-effects of opioids after surgery were further assessed. Results One hundred and one patients were included in the analysis. Analysis revealed that the intraoperative pain threshold index readings were not significantly different between the groups from incision to the end of the operation (P = 0.06). Furthermore, similar changes in the brain wavelet index readings were observed in the OFA and OA groups. There was no statistical difference in VAS scores between the groups (P > 0.05); however, non-opioid anesthesia did reduce the rescue analgesic consumption after operation (P < 0.05). In the OFA group, the blood glucose levels increased by 20% compared to baseline and were significantly higher than those in the OA group (P < 0.001). The incidences of postoperative nausea and vomiting, urine retention, intestinal paralysis and pruritus were not significantly different from those in the OA group (P > 0.05). Conclusions This study suggests that compared to the opioid anesthesia regimen, our opioid-free anesthesia regimen achieved an equally effective intraoperative pain threshold index in laparoscopic radical colectomy. The incidence of opioid-related adverse reactions was not different between regimens, and intraoperative blood glucose levels were higher with opioid-free anesthesia. Trial registration ChiCTR1900021223, 02/02/2019, Title: " Opioid-free anesthesia in laparoscopic surgery: a randomized controlled trial ". Website: hppts://www.chictr.ogr.cn

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“…The use of opioids in surgical patients is a particular challenge, having to balance the management of acute pain while minimizing risks of continuous opioid use postoperatively [11]. Despite attempts to decrease postmastectomy opioid use, including regional anesthetics, gabapentinoids, topical anesthetics, and nonopioid anesthesia, prolonged opioid use remains clinically significant among these patients [12].…”

Section: Introductionmentioning

confidence: 99%

Predictive Analytics for Inpatient Postoperative Opioid Use in Patients Undergoing Mastectomy

Dolendo¹,

Wallace²,

Armani³

et al. 2022

Cureus

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Introduction: The use of opioids in mastectomy patients is a particular challenge, having to balance the management of acute pain while minimizing risks of continuous opioid use postoperatively. Despite attempts to decrease postmastectomy opioid use, including regional anesthetics, gabapentinoids, topical anesthetics, and nonopioid anesthesia, prolonged opioid use remains clinically significant among these patients. The goal of this study is to identify risk factors and develop machine-learning-based models to predict patients who are at higher risk for postoperative opioid use after mastectomy. Methods: In this retrospective cohort study, we collected data from patients that underwent mastectomy procedures. The primary outcome of interest was defined as oxycodone milligram equivalents (OME) greater than or equal to the 75% of OME use on a postoperative day 1. Model performance (area under the receiveroperating characteristics curve (AUC)) of various machine learning approaches was calculated via 10-fold cross-validation. Odds ratio (OR) and 95% confidence intervals (CI) were reported.Results: There were a total of 148 patients that underwent mastectomy and were included. The medium (quartiles) postoperative day 1 opioid use was 5 mg OME (0.25 mg OME). Using multivariable logistic regression, the most protective factors against higher opioid use was being postmenopausal (OR: 0.13, 95% CI: 0.03-0.61, p = 0.009) and cancer diagnosis (OR: 0.19, 95% CI: 0.05-0.73, p = 0.01). The AUC was 0.725 (95% CI: 0.572-0.876). There was no difference in the performance of other machine-learning-based approaches.Conclusions: The ability to predict patients' postoperative pain could have a significant impact on preoperative counseling and patient satisfaction.

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Opioid-free anesthesia for breast cancer surgery: An observational study

Cited by 48 publications

References 22 publications

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

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

Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study

Predictive Analytics for Inpatient Postoperative Opioid Use in Patients Undergoing Mastectomy

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