Opioid-free anesthesia: A systematic review and meta-analysis

Feenstra, Minke L.; Jansen, Simone; Eshuis, Wietse J.; van Berge Henegouwen, Mark I.; Hollmann, Markus W.; Hermanides, Jeroen

doi:10.1016/j.jclinane.2023.111215

Cited by 19 publications

(7 citation statements)

References 55 publications

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“…Previous studies have found that opioid-free anesthesia can reduce postoperative nausea and vomiting in patients (Frauenknecht et al, 2019;Salomé et al, 2021;Feenstra et al, 2023;Malo-Manso et al, 2023;Zhang et al, 2023) and improve the quality of postoperative recovery (Feenstra et al, 2023), which is consistent with the results of this meta-analysis of opioid-free gynecological surgery. But two meta-analyses found that opioid-free anesthesia reduced postoperative pain in patients (Malo-Manso et al, 2023;Zhang et al, 2023) and one showed that opioid-free anesthesia reduced extubation time (Zhang et al, 2023), which is different from our results.…”

Section: Discussionsupporting

confidence: 92%

“…Mulier et al distinguishes OFA from opioid-free analgesia, and believes that OFA means that opioids are not used before or during surgery until the patient is awake ( Mulier and Dekock, 2017 ). It can reduce the risk for common opioid-related adverse reactions, such as postoperative respiratory depression, and PONV, and reduce the potential for dependence and addiction of patients to opioids ( Feenstra et al, 2023 ). OFA has been widely used in bariatric and thoracic surgeries, and ideal results have been obtained ( Selim et al, 2022 ; Mieszczański et al, 2023 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis

Zhang,

Li,

et al. 2024

Front. Pharmacol.

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Background: Postoperative nausea and vomiting (PONV) is a common complication, that can reduce patient satisfaction and may lead to serious consequences, such as wound dehiscence. Many strategies have been proposed to prevent PONV; however, it remains common, especially in high-risk surgeries such as gynecological surgery. In recent years, opioid-free anesthesia has been widely studied because it minimizes adverse reactions of opioids, such as nausea, vomiting, and itching; however, conclusions have been inconsistent. Therefore, we conducted this meta-analysis to investigate the effects of opioid-free anesthesia on PONV in patients undergoing gynecological surgery.Methods: A systematic search of the PubMed, Web of Science, Cochrane Library, and Embase databases, from inception to 28 August 2023, was performed. Keywords and other free terms were used with Boolean operators (OR and, AND) to combine searches. This review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).Results: Six studies involving 514 patients who underwent gynecological surgery were included. The forest plot revealed that the incidence of PONV (risk ratio = 0.52; p < 0.00001) and consumption of postoperative antiemetics use (risk ratio = 0.64; p = 0.03) were significantly lower in the opioid-free anesthesia group. In addition, opioid-free anesthesia improved the quality of recovery (mean difference = 4.69; p < 0.0001). However, there were no significant differences in postoperative pain scores (mean difference = 0.05; p = 0.85), analgesic use (risk ratio = 1.09; p = 0.65), and the time of extubation (mean difference = −0.89; p = 0.09) between the opioid-free anesthesia and control groups.Conclusion: OFA reduces PONV and the use of antiemetic drugs. In addition, it improves the quality of postoperative recovery. However, OFA can not reduce the postoperative pain scores, analgesic use and the time of extubation. Due to the strength of the evidence, we cannot support OFA as an ideal anesthesia method in gynecological surgery, and the implementation of anesthesia strategies should be case-by-case.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=462044], identifier [CRD42023462044]

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis

Zhang,

Li,

et al. 2024

Front. Pharmacol.

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“…Estratégias poupadoras ou que reduzem o uso de opioides reduzem a incidência de tal complicação. (Feenstra et al, 2023) O tipo de cirurgia também exerce efeito no risco da NVPO. Procedimentos como colecistectomia, ginecológicos e laparoscópicos estão associados a um risco modestamente aumentado da complicação em comparação com outros procedimentos cirúrgicos gerais.…”

Section: Resultsunclassified

Náusea e vômito pós-operatórios: Revisão de literatura

Alves,

Andrade,

Souza

et al. 2024

RSD

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O termo náusea e vômito pós-operatórios (NVPO) é normalmente usado para descrever náuseas e/ou vômitos na sala de recuperação pós-anestésica (SRPA) ou nas 24 horas imediatas de pós-operatório. Configura-se como uma resposta adversa multifatorial à anestesia e operação cirúrgica que é temida pelos pacientes, geralmente classificada como pior do que a dor pós-operatória. O presente estudo teve como objetivo trazer o que há de mais atual em relação à fisiopatologia, fatores de risco, profilaxia e tratamento da NVPO, baseando-se em evidências científicas e nas diretrizes mais recentes. A pesquisa apresentada refere-se a uma revisão narrativa da literatura. Foram realizadas buscas nos periódicos indexados nas bases de dados do PubMed, LILACS e SciELO. Além disso, foi feita uma busca nos livros de significativa importância na área da Anestesiologia. Apesar de ainda não estar 100% elucidada, algumas vias fisiopatológicas da NVPO já estão bem descritas. Em relação aos fatores de risco, a literatura estabelece bem alguns fatores como sexo feminino, status de não tabagista, histórico de NVPO e uso de opioides na cirurgia, além de outros fatores que são discutidos. A profilaxia e tratamento se baseiam na diretriz lançada em 2020 por Gan e seus colegas. A NVPO traz consigo um impacto negativo no bem-estar do paciente. Dessa forma, a NVPO configura como uma complicação de alto impacto e prevalência, apesar do avanço da ciência em relação ao tópico. É papel do médico estar ciente dos riscos, à fim de evitar tal complicação.

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“…However, certain drawbacks of OFA have been noted, such as comparable postoperative pain scores to OBA and an increased incidence of bradycardia when dexmedetomidine is included in the OFA regimen. 33 Patients who receive OFA with dexmedetomidine are confronted with delayed extubation, prolonged PACU stay, increased hypoxaemia and bradycardia after non-cardiac surgery. 11 …”

Section: Discussionmentioning

confidence: 99%

Effect of modified opioid sparing anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery: protocol for a monocentre, double-blind randomised controlled trial – the MOSA study

Li,

Zhang

et al. 2024

BMJ Open

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IntroductionObesity patients undergoing laparoscopic bariatric surgery (LBS) are frequently encountered perioperative adverse events related to opioids-based anaesthesia (OBA) or opioids-free anaesthesia (OFA). While modified opioid-sparing anaesthesia (MOSA) has been shown to lower the occurrence of adverse events related to OBA and OFA. This study is to assess the efficacy of MOSA in enhancing the recovery quality among individuals undergoing LBS.Methods and analysisA single-centre, prospective, double-blind, randomised controlled trial is conducted at a tertiary hospital. A total of 74 eligible participants undergoing elective LBS will be recruited and randomly allocated. Patients in the MOSA group will receive a combination of low-dose opioids, minimal dexmedetomidine, esketamine and lidocaine, while in the OBA group will receive standard general anaesthesia with opioids. Patients in both groups will receive standard perioperative care. The primary outcome is the quality of recovery-15 score assessed at 24 hours after surgery. Secondary outcomes include pain levels, anxiety and depression assessments, gastrointestinal function recovery, perioperative complication rates, opioid consumption and length of hospital stay.Ethics and disseminationEthical approval has been provided by the Ethical Committee of Yan’an Hospital of Kunming City (approval No. 2023-240-01). Eligible patients will provide written informed consent to the investigator. The outcomes of this trial will be disseminated in a peer-reviewed scholarly journal.Trial registration numberThe study protocol is registered athttps://www.chictr.org.cn/on 19 December 2023. (identifier: ChiCTR2300078806). The trial was conducted using V.1.0.

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Opioid-free anesthesia: A systematic review and meta-analysis

Cited by 19 publications

References 55 publications

Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis

Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis

Náusea e vômito pós-operatórios: Revisão de literatura

Effect of modified opioid sparing anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery: protocol for a monocentre, double-blind randomised controlled trial – the MOSA study

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