Opioid-Free Anaesthesia Effectiveness in Thoracic Surgery—Objective Measurement with a Skin Conductance Algesimeter: A Randomized Controlled Trial

Abstract

Background: Chest surgery is associated with significant pain, and potent opioid medications are the primary medications used for pain relief. Opioid-free anaesthesia (OFA) combined with regional anaesthesia is promoted as an alternative in patients with an opioid contraindication. Methods: Objective: To assess the efficacy of OFA combined with a paravertebral block in pain treatment during video-assisted thoracic surgery. Design: A randomized, open-label study. Setting: A single university hospital between December 2015 and March 2018. Participants: Sixty-six patients scheduled for elective video-assisted thoracic surgery were randomized into two groups. Of these, 16 were subsequently excluded from the analysis. Interventions: OFA combined with a paravertebral block with 0.5% bupivacaine in the OFA group; typical general anaesthesia with opioids in the control group. Main outcome measures: Intraoperative nociceptive intensity measured with a skin conductance algesimeter (SCA) and traditional intraoperative monitoring. Results: Higher mean blood pressure was observed in the control group before induction and during intubation (p = 0.0189 and p = 0.0095). During chest opening and pleural drainage, higher SCA indications were obtained in the control group (p = 0.0036 and p = 0.0253), while in the OFA group, the SCA values were higher during intubation (p = 0.0325). SCA during surgery showed more stable values in the OFA group. Pearson analysis revealed a positive correlation between the SCA indications and mean blood pressure in both groups. Conclusions: OFA combined with a paravertebral block provides effective nociception control during video-assisted thoracic surgery and can be an alternative for general anaesthesia with opioids. OFA provides a stable nociception response during general anaesthesia, as measured by SCA.

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

“…23,37 The goals of perioperative non-opioid analgesia are widely used in many surgical procedures, specifically endoscopic techniques, such as gynaecological procedures, bariatric surgery, general surgery and neurosurgery. [38][39][40] LOA and OFA meet the principles of modern perioperative safety resulting from the ERAS protocol. 22,24,41 Female gender, PONV in medical history, motion sickness, non-smoking status, a young age, general anaesthesia with volatile agents and nitrous oxide, opioid-postoperative analgesia, laparoscopic surgery, gynaecological procedures, and the duration of anaesthesia were described as a risk factors.…”

“…The goals of perioperative non-opioid analgesia are widely used in many surgical procedures, specifically endoscopic techniques, such as gynaecological procedures, bariatric surgery, general surgery and neurosurgery. 38–40 LOA and OFA meet the principles of modern perioperative safety resulting from the ERAS protocol. 22 , 24 , 41 …”

Assessment of feasibility of opioid-free anesthesia combined with preoperative thoracic paravertebral block and postoperative intravenous patient-controlled analgesia oxycodone with non-opioid analgesics in the perioperative anesthetic management for video-assisted thoracic surgery

“…Reduced mobility and inability to undergo rehabilitation increase the risk of thromboembolic complications. Elderly patients may experience mental disorders, often with episodes of depression, anxiety, or agitation [ 20 ]. All abovementioned features make our intended population quite challenging.…”

“…The presented data are a sub-analysis of a population that has already been studied before by our group. The results were published in a previous paper that focused on objective pain assessment during surgery using a skin conductance algesimeter [ 12 ].…”

“…1 im. Prof. S. Szyszko 3 Maja 13-15 41-800 Zabrze, Poland) of the Medical University of Silesia, Poland [ 12 ].…”