Opiate Anaesthesia

Stanley, Theodore H.

doi:10.1177/0310057x8701500107

Cited by 15 publications

(7 citation statements)

References 170 publications

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“…Opioids being the strongest analgesics available, are essential in the treatment of pain during the peri-operative period. Additionally, they provide balanced anesthesia with less hemodynamic instability 3 . Despite the effectiveness of these drugs, they are associated with numerous side effects with varying severity: respiratory depression; a short moment of muscular stiffness and weak pharyngeal musculature (hence obstructive breathing problems); somnolence; dizziness; nausea and vomiting; constipation; itching and; urinary retention.…”

Section: Opioid Anesthesiamentioning

confidence: 99%

Impact of opioid free anesthesia on glycemia: a randomized controlled trial

Van Loocke,

Heintz,

Mulier

2022

Acta Anaest Belg

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Background: General anesthesia induces frequently hyperglycemia. This is associated with an increased risk of morbidity and mortality in patients undergoing surgery. The type of anesthesia used may affect the severity of the peri-operative hyperglycemia. Methods: Patients undergoing an elective primary laparoscopic bariatric surgery at AZ Sint-Jan Brugge between February 2022 and March 2022 were randomized between opioid-free anesthesia (OFA) and opioid anesthesia (OA) after ethical approval. Any patient with diabetes type 1, diabetes type 2, having glucose intolerance at the time of surgery, or during pregnancy were excluded from the study. Dexmedetomidine, lidocaine, ketamine, and magnesium were used for the OFA, while sufentanil was given in the OA. No intravenously steroids were administered to protect the peritoneum nor as antiemetic prophylaxis. The increase in blood glucose level at 180’ was assessed as the primary outcome. A first measurement was taken just before the anesthesia induction (T0), followed by a measurement every hour (T60’, T120’, and T180’). As secondary endpoints, the total dose of opioids given in the first 24 hours and the postoperative pain using the VAS (visual analog scale) score were measured. Additionally, postoperative nausea and vomiting (PONV), duration of surgery, and surgical and/or anesthetic complications were recorded. Results: A total of 43 patients underwent an elective primary laparoscopic bariatric surgery. 22 patients received OFA and 20 patients received OA and were analyzed. One patient from the OA group withdrew written consent. 2 patients from the OFA group were lost to follow up having therefore 19 in the OA and 20 in the OFA for analysis. There were no significant differences between the two groups regarding age, BMI, gender, duration of surgery, and pre-induction glycemia. The glycemia level increased in both groups but increased significantly higher in the OA group at 180 minutes (Mann-Whitney test p = 0.027). OFA was associated with lower VAS scores postoperative (OFA: 3(2-4) vs OA: 4(4-5,5)) and a reduced need for postoperative opioids (OFA: 4.9(2,4-7,2) mg versus OA: 10,4(8,4-12,7) mg). Conclusion: This research suggest that the use of opioid-free anesthesia causes a smaller increase in glycemia during elective laparoscopic bariatric surgery compared to opioid anesthesia. Furthermore, patients undergoing OFA showed higher levels of postoperative comfort, demonstrated through the lower postoperative VAS scores and the reduced need for postoperative opioids.

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Section: Opioid Anesthesiamentioning

confidence: 99%

Impact of opioid free anesthesia on glycemia: a randomized controlled trial

Van Loocke,

Heintz,

Mulier

2022

Acta Anaest Belg

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“…Of note, pharmacologic opioid minimisation strategies during the intraoperative period are being adopted despite limited evidence to inform best practice and with large variation in practices 25–27. While the results of previous reviews and randomised controlled trials (RCTs) suggest that opioid alternatives can reduce short-term opioid use during and after surgery, they have focused primarily on the effect of pharmacologic opioid minimising strategies on surrogate outcome measures, such as short-term quantity of opioids administered, haemodynamic stability or unidimensional instruments (eg, pain intensity assessment) 6–18 28–46. There is a paucity of evidence regarding the impact of opioid minimisation strategies on long-term opioid use and outcomes that are the most meaningful to patients.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative pharmacologic opioid minimisation strategies and patient-centred outcomes after surgery: a scoping review protocol

et al. 2023

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IntroductionFor close to a century opioid administration has been a standard of care to complement anaesthesia during surgery. Considering the worldwide opioid epidemic, this practice is now being challenged and there is a growing use of systemic pharmacological opioid minimising strategies. Our aim is to conduct a scoping review that will examine clinical trials that have evaluated the impact of intraoperative opioid minimisation strategies on patient-centred outcomes and identify promising strategies.Methods and analysisOur scoping review will follow the framework developed by Arksey and O’Malley. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL from their inception approximately in March 2023. We will include randomised controlled trials, assessing the impact of systemic intraoperative pharmacologic opioid minimisation strategies on patient-centred outcomes. We define an opioid minimisation strategy as any non-opioid drug with antinociceptive properties administered during the intraoperative period. Patient-centred outcomes will be defined and classified based on the consensus definitions established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC group) and informed by knowledge users and patient partners. We will use a coproduction approach involving interested parties. Our multidisciplinary team includes knowledge users, patient partners, methodologists and knowledge user organisations. Knowledge users will provide input on methods, outcomes, clinical significance of findings, implementation and feasibility. Patient partners will participate in assessing the relevance of our design, methods and outcomes and help to facilitate evidence translation. We will provide a thorough description of available clinical trials, compare their reported patient-centred outcome measures with established recommendations and identify promising strategies.Ethics and disseminationEthics approval is not required for the review. Our scoping review will inform future research including clinical trials and systematic reviews through identification of important intraoperative interventions. Results will be disseminated through a peer-reviewed publication, presentation at conferences and through our network of knowledge user collaborators.RegistrationOpen Science Foundation (currently embargoed)

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“…This technique was based on balancing anaesthetics with large doses of intravenous fentanyl (50 µg/kg) during surgical procedures. These methods were revolutionary due to their simplicity, safety (haemodynamic stability), minimal effect on haemostasis, and apparent comfort post-procedure—which had not yet been seen in the field [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review

Goff

Hina

Malik

et al. 2023

JPM

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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.

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Opiate Anaesthesia

Cited by 15 publications

References 170 publications

Impact of opioid free anesthesia on glycemia: a randomized controlled trial

Impact of opioid free anesthesia on glycemia: a randomized controlled trial

Intraoperative pharmacologic opioid minimisation strategies and patient-centred outcomes after surgery: a scoping review protocol

Can Opioid-Free Anaesthesia Be Personalised? A Narrative Review

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