Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review

Abstract

Background: A significant amount of evidence suggests that Opioid-Free Anaesthesia (OFA) may provide better outcomes for patients undergoing surgery, sparing patients who are particularly vulnerable to adverse side effects of opioids. However, to what extent personalizing OFA is feasible and beneficial has not been adequately described. Methods: We conducted a narrative literature review aiming to provide a comprehensive understanding of nociception and pain and its context within the field of OFA. Physiological (including monitoring), pharmacological, procedural (type of surgery), genetical and phenotypical (including patients’ conditions) were considered. Results: We did not find any monitoring robustly associated with improved outcomes. However, we found evidence supporting particular OFA indications, such as bariatric and cancer surgery. We found that vulnerable patients may benefit more from OFA, with an interesting field of research in patients suffering from vascular disease. We found a variety of techniques and medications making it impossible to consider OFA as a single technique. Our findings suggest that a vast field of research remains unexplored. In particular, a deeper understanding of nociception with an interest in its genetic and acquired contributors would be an excellent starting point paving the way for personalised OFA. Conclusion: Recent developments in OFA may present a more holistic approach, challenging the use of opioids. Understanding better nociception, given the variety of OFA techniques, may help to maximize their potential in different contexts and potential indications.

Continuous Erector Spinae and Serratus-Intercostal Block With Ketamine-Dexmedetomidine Sedation for Quadrantectomy and Axillary Dissection in a Multimorbid Patient

“…This condition is frequently linked to reduced quality of life, particularly in older individuals, and poses a significant challenge for healthcare professionals, including clinicians, surgeons, and anesthesiologists. Given the increased risk that such patients face during surgery, it is recommended that minimally invasive anaesthesia be used in such cases [ 9 ]. The primary objectives of preoperative medical assessments are to minimize the risk of surgical and anaesthetic complications and enable patients to return to their desired physical state as quickly as possible [ 10 ].…”

“…New evidence suggests that OFA can lead to better results for patients who undergo surgery, particularly for those who are more susceptible to the negative effects of opioids [ 9 ]. OFA is a multi-faceted analgesic technique designed to avoid opioid tolerance.…”

“…The primary reasons for utilizing OFA are in bariatric and oncological surgery, as well as for vulnerable patients who can benefit the most from this method [ 19 ]. However, there is a wide range of techniques and drugs available, making it impossible to consider OFA as a single technique [ 9 ]. A better understanding of nociception and its genetic and acquired factors would be an excellent starting point to pave the way for personalized OFA.…”

Opioids and opioid receptors; understanding pharmacological mechanisms as a key to therapeutic advances and mitigation of the misuse crisis

“…There is literature exploring personalisation of opioid-free anaesthesia; or at least posing the question. 132 There is a wide literature base exploring opioid-free techniques per se and a critical review recently compared opioid and opioid-free approaches concluding that ‘ The data indicate that opioid-free strategies, however noble in their cause, do not fully acknowledge the limitations and gaps within the existing evidence and clinical practice considerations. ’ 133 , 134 , 135 , 136 …”

Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block

“…Dexmedetomidine's opioid-sparing effect reduces the need for systemic opioids, minimizing the risks associated with opioid use in these high-risk populations. This approach aligns to enhance patient safety and optimize outcomes in vulnerable patient groups [65].…”