Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Salomé, Arthur; Harkouk, Hakim; Fletcher, Dominique; Martinez, Valéria

doi:10.3390/jcm10102069

Cited by 62 publications

(42 citation statements)

References 56 publications

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“…However, a lower opioid request was registered in the opioid-inclusive strategy group [ 22 ]. On the contrary, Salome et al found that OFA is associated with a reduction in the pain score at 2 h [−0.75 (−1.18, −0.32)], followed by reduction in morphine administration at 2 and 24 h after surgery [MD: −1.61 (−2.69, −0.53) and −1.73 (−2.82, −0.65) ( p < 0.05)] [ 23 ]. Similarly, also Fletcher described a decreased opioid consumption and postoperative pain at 24 h in the OFA group [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

D’Amico

Barucco

Licheri

et al. 2022

JCM

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Introduction: Recent studies showed that balanced opioid-free anesthesia is feasible and desirable in several surgical settings. However, in thoracic surgery, scientific evidence is still lacking. Thus, we conducted the first systematic review and meta-analysis of opioid-free anesthesia in this field. Methods: The primary outcome was the occurrence of any complication. Secondary outcomes were the length of hospital stay, recovery room length of stay, postoperative pain at 24 and 48 h, and morphine equivalent consumption at 48 h. Results: Out of 375 potentially relevant articles, 6 studies (1 randomized controlled trial and 5 observational cohort studies) counting a total of 904 patients were included. Opioid-free anesthesia compared to opioid-based anesthesia, was associated with a lower rate of any complication (74 of 175 [42%] vs. 200 of 294 [68%]; RR = 0.76; 95% CI, 0.65–0.89; p < 0.001; I2 = 0%), lower 48 h morphine equivalent consumption (MD −14.5 [−29.17/−0.22]; p = 0.05; I2 = 95%) and lower pain at 48 h (MD −1.95 [−3.6/0.3]; p = 0.02, I = 98%). Conclusions: Opioid-free anesthesia in thoracic surgery is associated with lower postoperative complications, and less opioid demand with better postoperative analgesia at 48 h compared to opioid-based anesthesia.

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Section: Discussionmentioning

confidence: 99%

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

D’Amico

Barucco

Licheri

et al. 2022

JCM

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“…A recent meta-analysis, including 33 RCTs and 2209 participants, showed no clinically significant benefits in terms of pain and opioid use after surgery, but a clear benefit with respect to a reduction in PONV was demonstrated when intraoperative opioids were avoided [37]. In a previous meta-analysis and systematic review of 23 trials, Frauenknecht et al reported that OFA did not reduce pain scores after surgery, but it was associated with a decreased rate of PONV with a risk ratio of 0.77 (95%CI (0.61-0.97), p = 0.03) [14].…”

Section: Discussionmentioning

confidence: 99%

Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study

Benedetto

Pelli

Loffredo

et al. 2021

J Anesth Analg Crit Care

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Background Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV). Results A total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups. Conclusions A combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.

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“…8 In two meta-analyses, patients receiving OFA had a lower incidence of PONV than those receiving opioid-based anesthesia but had similar postoperative pain scores. 9 , 10 In another meta-analysis, OFA significantly reduced adverse postoperative events with significantly lower postoperative opioid consumption. 11 However, the literature on OFA is still controversial because some studies that have not shown benefits 12 , 13 or worse outcomes.…”

Section: Introductionmentioning

confidence: 97%

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Choi¹,

Song²,

Oh³

et al. 2022

JPR

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Purpose Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy. Patients and Methods Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels. Results The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group ( p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group ( p = 0.002). Conclusion OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

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Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 62 publications

References 56 publications

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

Opioid Free Anesthesia in Thoracic Surgery: A Systematic Review and Meta Analysis

Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study

The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

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