Opioid-free anesthesia in oncologic surgery: the rules of the game

Abstract

Background Opioids are frequently used in the postoperative period due to their analgesic properties. While these drugs reduce nociceptive somatic, visceral, and neuropathic pain, they may also lead to undesirable effects such as respiratory depression, urinary retention, nausea and vomiting, constipation, itching, opioid-induced hyperalgesia, tolerance, addiction, and immune system disorders. Anesthesiologists are in the critical position of finding balance between using opioids when they are necessary and implementing opioid-sparing strategies to avoid the known harmful effects. This article aims to give an overview of opioid-free anesthesia. Main body This paper presents an overview of opioid-free anesthesia and opioid-sparing anesthetic techniques. Pharmacological and non-pharmacological strategies are discussed, highlighting the possible advantages and drawbacks of each approach. Conclusions Choosing the best anesthetic protocol for a patient undergoing cancer surgery is not an easy task and the available literature provides no definitive answers. In our opinion, opioid-sparing strategies should always be implemented in routine practice and opioid-free anesthesia should be considered whenever possible. Non-pharmacological strategies such as patient education, while generally underrepresented in scientific literature, may warrant consideration in clinical practice.

External Oblique Intercostal Plane Block Versus Port-Site Infiltration for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study

“…In addition, opioid-based anesthesia has been reported to contribute to a reduced risk of persistent postoperative pain. For these reasons, clinical efforts are being made to develop opioid-free and opioid-sparing anesthesia strategies [ 16 – 18 ].…”

Interpectoral and Pectoserratus Plane Block vs. Local Anesthetic Infiltration for Partial Mastectomy: A Prospective Randomized Trial

“…It has been documented in the ERAS society recommendations that opioid sparing is an important component of good and fast recovery after surgery [ 35 ]. Regional anesthesia has proven to be an effective alternative to opioids for postoperative pain [ 36 ]. A multimodal approach using acetaminophen, NSAID, betamethasone, and clonidine might reduce the importance of IPP/PSP compared to advanced local anesthetic infiltration.…”

Effect of rectus sheath anaesthesia versus thoracic epidural analgesia on postoperative recovery quality after elective open abdominal surgery in a French regional hospital: the study protocol of a randomised controlled QoR-RECT-CATH trial

“…With regards to the latter, locoregional anaesthesia is advised to reduce intraoperative and postoperative morphine requirements 4 5. This reflects the fact that high perioperative opioid doses increase postoperative complications,6 including fatigue, prolonged bed rest, delayed bowel function resumption and depressed immune responses 7–10. One way to reduce perioperative opioid doses is to use opioid-free anaesthesia (OFA) 11 12.…”

“…One way to reduce perioperative opioid doses is to use opioid-free anaesthesia (OFA) 11 12. Indeed, many hospitals, including ours,13 now routinely employ OFA for all abdominal carcinoma operations 10…”

“… 11 12 Indeed, many hospitals, including ours, 13 now routinely employ OFA for all abdominal carcinoma operations. 10 …”