Opioid-free anesthesia: the next frontier in surgical patient safety

McLott, Jason; Stahel, Philip F.

doi:10.1186/s13037-022-00346-5

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…It can thus be expected that OFA, after further optimization, may provide lower expenses and shortened hospital stays in the future compared with OSA. While OFA represents a the promising frontier in enhancing surgical patient safety (32), it is curcial to acknowledge that, given its advantages and disadvantages, OFA may not universally serve as the primary choice for all surgical patients (33,34).…”

Section: Discussionmentioning

confidence: 99%

Opioid-free anesthesia reduces the severity of acute postoperative motion-induced pain and patient-controlled epidural analgesia-related adverse events in lung surgery: randomized clinical trial

Wang,

Li,

Liang

et al. 2023

Front. Med.

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BackgroundOpioids have been used as pain relievers for thousands of years. However, they may also cause undesirable side effects. We therefore performed this study to compare the effect of opioid-free anesthesia (OFA) versus opioid-sparing anesthesia (OSA) on postoperative pain and patient-controlled epidural analgesia (PCEA)-related events.MethodsThis is a single center randomized clinical trial that was recruited patients aged from 18 to 70 years who received video-assisted lung surgery between October 2021 and February 2022. Participants were 1:1 randomly assigned to OFA or OSA. Patients in the OFA group received propofol, rocuronium, esmolol, lidocaine, and magnesium sulfate intravenously with epidural ropivacaine. Patients in the OSA group received propofol, rocuronium, remifentanil, and sufentanil intravenously with epidural hydromorphone and ropivacaine.ResultsA total number of 124 patients were randomly allocated to the OFA or OSA group. In the OFA group, the severity of pain during coughs on the first postoperative days (PODs; VAS score 1.88 ± 0.88 vs. 2.16 ± 1.1, p = 0.044) was significantly lower than that in the OSA group. The total ratio of PCEA-related adverse events in the OFA group [11 (19.6%) vs. 26 (47.3%), p = 0.003] was significantly lower than in the OSA group.ConclusionOFA in patients who received video-assisted lung surgery led to lower severity of acute postoperative motion-induced pain and fewer PCEA-related adverse events on the first POD than in the patients in the OSA group.Clinical trial registrationclinicaltrials.gov, identifier (NCT05063396).

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Section: Discussionmentioning

confidence: 99%

Opioid-free anesthesia reduces the severity of acute postoperative motion-induced pain and patient-controlled epidural analgesia-related adverse events in lung surgery: randomized clinical trial

Wang,

Li,

Liang

et al. 2023

Front. Med.

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“…Despite their important role in pain management, the undesired effects may impact negatively on patients' recovery. Some experiences exist about opioid-free anesthesia, with the claim of more patient safety [64]. For this reason, opioids use should be limited to short-acting drugs avoiding morphine to minimize residual effects and to warrant rapid recovery [65].…”

Section: Opioidsmentioning

confidence: 99%

Enhanced perioperative care in emergency general surgery: the WSES position paper

Ceresoli,

Braga,

Zanini

et al. 2023

World J Emerg Surg

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Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients’ outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.

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“…5 For many of these clinical indications, prolonging the duration of lidocaine infusion offers a therapeutic advantage and minimisation of opioid-related side-effects. 6 However, maintaining safety reliably during prolonged intravenous infusion has proven problematic due to the risk of inadvertent intravenous bolus 7 and unrecognised systemic accumulation. [8][9][10][11] As a consequence, many institutional guidelines advise that postoperative lidocaine infusions take place in critical care areas with continuous cardiac monitoring, and few clinicians are comfortable outside of these restrictions.…”

Section: Introductionmentioning

confidence: 99%

Serum lidocaine (lignocaine) concentrations during prolonged perioperative infusion in patients undergoing breast cancer surgery: A secondary analysis of a randomised controlled trial

Toner,

Bailey,

Schug

et al. 2023

Anaesth Intensive Care

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Perioperative lidocaine (lignocaine) infusions are being employed with increasing frequency. The determinants of systemic lidocaine concentrations during prolonged administration are unclear. In the Long-term Outcomes after Lidocaine Infusions for PostOperative Pain (LOLIPOP) pilot trial, the impact of infusion duration and body size metrics on serum lidocaine concentrations was examined with regression models in 48 women undergoing breast cancer surgery. Lidocaine was delivered as an intravenous bolus (1.5 mg/kg) and infusion (2 mg/kg per h) intraoperatively, followed by a 12-h subcutaneous infusion (1.33 mg/kg per h) postoperatively. Dosing was based on total body weight. Wound infiltration with other long-acting local anaesthetics was permitted. Protein binding and pharmacogenomic data were also collected. Lidocaine concentrations (median (interquartile range) (range)) during prolonged administration were in the safe and potentially therapeutic range: post-anaesthesia care unit 2.16 (1.73–2.82) (1.12–6.06) µg/ml; ward 1.41 (1.22–1.75) (0.64–2.81) µg/ml. Concentrations increased non-linearly during the early intravenous phase of administration (mean rise 1.21 µg/ml per hour of infusion, P = 0.007) but reached a pseudo steady-state during the later subcutaneous phase. Higher dose rates received per kilogram of lean ( P = 0.004), adjusted ( P = 0.006) and ideal body weight ( P = 0.009) were associated with higher steady-state concentrations. The lidocaine free fraction was unaffected by the presence of ropivacaine, and phenotypes linked to slow metabolism were infrequent. Serum lidocaine concentrations reached a pseudo steady-state during a 12-h postoperative infusion. Greater precision in steady-state concentrations can be achieved by dosing on lean body weight versus adjusted or ideal body weight (equivalent lean body weight doses: intravenous bolus 2.5 mg/kg; intravenous infusion 3.33 mg/kg per h; subcutaneous infusion 2.22 mg/kg per h.

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Opioid-free anesthesia: the next frontier in surgical patient safety

Cited by 5 publications

References 18 publications

Opioid-free anesthesia reduces the severity of acute postoperative motion-induced pain and patient-controlled epidural analgesia-related adverse events in lung surgery: randomized clinical trial

Opioid-free anesthesia reduces the severity of acute postoperative motion-induced pain and patient-controlled epidural analgesia-related adverse events in lung surgery: randomized clinical trial

Enhanced perioperative care in emergency general surgery: the WSES position paper

Serum lidocaine (lignocaine) concentrations during prolonged perioperative infusion in patients undergoing breast cancer surgery: A secondary analysis of a randomised controlled trial

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