Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Guinot, Pierre-Grégoire; Spitz, Alexandra; Berthoud, Vivien; Ellouze, Omar; Missaoui, Anis; Constandache, Tiberiu; Grosjean, Sandrine; Radhouani, Mohamed; Anciaux, Jean Baptiste; Parthiot, Jean Philippe; Merle, J.P.; Nowobilski, Nicolas; Nguyen, Maxime; Bouhemad, Bélaïd

doi:10.1186/s12871-019-0802-y

Cited by 51 publications

(70 citation statements)

References 33 publications

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“…In our study, patients with a low-opioid anesthesia scheme had a shorter duration of mechanical ventilation and stay in the ICU, which was consistent with the work of Guinot's et al, who used lidocaine, dexamethasone, and ketamine for the low-opioid anesthesia scheme [21].…”

Section: Discussionsupporting

confidence: 91%

Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6

Loskutov¹,

Maruniak²,

Dryzhyna

et al. 2020

kitp

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Introduction With coronary artery bypass grafting, patients are subjected to additional risk caused by both surgical treatment itself and pathophysiological changes in homeostasis, provoked by the action of anesthetics and cardiopulmonary bypass. Material and methods The study involved 60 patients, who had been subjected to coronary artery bypass grafting with cardiopulmonary bypass. All patients were divided into two groups: group I (30 patients) – low-opioid scheme of anesthesia and group II (30 patients) – standard scheme of anesthetic management. Blood interleukin-6 (IL-6) was identified before and after cardiopulmonary bypass using an ELISA test. Results Having compared IL-6 values between study groups after completion of cardiopulmonary bypass, it was established that IL-6 levels were 27.51% ( p = 0.001) lower in patients of group I compared with the results of patients in group II. Patients in the first group had a significantly shorter time of mechanical ventilation compared to group II (2.1 ±0.7 hours vs. 3.9 ±0.9 hours, p = 0.021). Low cardiac output syndrome was significantly less frequently reported in patients of group I (10.0% vs. 33.3%, p = 0.028). In addition, patients in group I had a significantly shorter time of intensive care unit (ICU) stay (2.5 ±0.7 days vs. 3.5 ±1.0 days, p = 0.044). Conclusions Application of multimodal low-opioid anesthesia was associated with significantly lower IL-6 at the end of surgery, shorter mechanical ventilation duration, less frequent low cardiac output syndrome and need for catecholamines, and shorter ICU stays.

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Section: Discussionsupporting

confidence: 91%

Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6

Loskutov¹,

Maruniak²,

Dryzhyna

et al. 2020

kitp

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“…Current research has shown that a lower dose of opioids has a positive effect on p/o recovery in patients who have undergone cardiac surgery with ABC [ 15 ], but further randomized studies are needed to confirm these results.…”

Section: Discussionmentioning

confidence: 99%

“…noted that the non-opioid group of patients showed higher intraoperative use of antihypertensive agents. They used ketamine, dexamethasone, and lidocaine in their regimen [ 15 ]. In our study, we did not note such hemodynamic features in the indicated scheme of multimodal low-opioid anesthesia.…”

Section: Discussionmentioning

confidence: 99%

The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Loskutov¹,

Danchyna²,

Dzuba³

et al. 2020

kitp

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Introduction Cardiovascular diseases (CVD) are the main cause of death worldwide, and according to experts, they will continue to dominate the structure of global mortality. Aim The effectiveness of the multimodal low-opioid anesthesia technique in performing coronary artery bypass graft operations with artificial blood circulation. Material and methods Ninety-six patients aged 61.8 ±10.4 years underwent coronary artery bypass grafting under artificial blood circulation. Group I: propofol, sevoflurane, fentanyl, pipecuronium bromide (standard doses). Group II: dexketoprofen trometamol (50 mg), intravenous lidocaine (1% – 1 mg/kg bolus) and continuous lidocaine infusion (1.5–2 mg/kg/h), propofol, ketamine (0.5 mg/kg), magnesia sulfate, minimal doses of fentanyl. Results Average duration of anesthesia – 257.4 ±19.1 min; assisted blood circulation – 55 ±10 min. Mean dose of fentanyl in group I – 4.66 ±1.58 µg/kg/h, in group II – 1.29 ±0.32 µg/kg/h.Standard lab values and stress hormonal changes were within the normal range (mean cortisol: 479.3 ±26.4 nmol/l, lactate 1.61 ±0.2 mmol/l, glucose 6.42 ±0.9 mmol/l). Changes in heart rate within group I had a significant amplitude of dynamics, while in group II, these values were relatively at the same level throughout the entire anesthetic provision. Mean arterial pressure changes in group I were characterized by a significant reduction at the stage of induction, support and sternum reduction, whereas in group II it was relatively at the same level during the entire anesthetic management and significantly differed from baseline only at the stage of induction. Conclusions Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes.

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“…Statistical analyses. Sample size calculation was based on a previously published study and institutional database 7 . The inclusion of 42 patients was needed to demonstrate a difference of 30% in the total dose of sufentanyl for a mean dose of 80 µg (± 27) between the two groups, with a power of 90% and a two-tailed p-value of 0.05.…”

Section: Randomizationmentioning

confidence: 99%

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Berthoud

Nguyen

Appriou

et al. 2020

Sci Rep

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Pupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

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Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study

Cited by 51 publications

References 33 publications

Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6

Influence of low-opioid anesthesia in cardiac surgery on dynamics of pro-inflammatory interleukin-6

The use of multimodal low-opioid anesthesia for coronary artery bypass grafting surgery in conditions of artificial blood circulation

Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

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