Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study

Abstract

Background Few studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an effective analgesia-antinociception balance monitored by the / pain threshold index in laparoscopic radical colectomy. Methods We enrolled 102 patients undergoing laparoscopic radical colectomy with general anesthesia. Participants were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine (loading dose with 0.6 μg·kg−1 for 10 min and then 0.5 μg·kg−1·h−1 continuous infusion) and sevoflurane plus bilateral paravertebral blockade (0.2 μg·kg−1 dexmedetomidine and 0.5% ropivacaine 15 ml per side) or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and bilateral paravertebral blockade (0.5% ropivacaine 15 ml per side). The primary outcome variable was pain intensity during the operation, as assessed by the pain threshold index with the multifunction combination monitor HXD- I. Results were analyzed using repeated measures analysis of variance and Student’s t-test. The secondary outcomes were wavelet index, lactic levels, and blood glucose concentration during the operation. The visual analog scale (VAS), rescue analgesic consumption, and side-effects of opioids after surgery were further assessed. Results One hundred and one patients were included in the analysis. Analysis revealed that the intraoperative pain threshold index readings were not significantly different between the groups from incision to the end of the operation (P = 0.06). Furthermore, similar changes in the brain wavelet index readings were observed in the OFA and OA groups. There was no statistical difference in VAS scores between the groups (P > 0.05); however, non-opioid anesthesia did reduce the rescue analgesic consumption after operation (P < 0.05). In the OFA group, the blood glucose levels increased by 20% compared to baseline and were significantly higher than those in the OA group (P < 0.001). The incidences of postoperative nausea and vomiting, urine retention, intestinal paralysis and pruritus were not significantly different from those in the OA group (P > 0.05). Conclusions This study suggests that compared to the opioid anesthesia regimen, our opioid-free anesthesia regimen achieved an equally effective intraoperative pain threshold index in laparoscopic radical colectomy. The incidence of opioid-related adverse reactions was not different between regimens, and intraoperative blood glucose levels were higher with opioid-free anesthesia. Trial registration ChiCTR1900021223, 02/02/2019, Title: " Opioid-free anesthesia in laparoscopic surgery: a randomized controlled trial ". Website: hppts://www.chictr.ogr.cn

Effect of opioid-free anesthesia on the incidence of postoperative nausea and vomiting: A meta-analysis of randomized controlled studies

“…Four RCTs specifically recruited female patients undergoing breast cancer or gynecologic surgery, [15–18] and the other 10 studies included surgical procedures for both male and female patients. [19–28]…”

“…Four RCTs specifically recruited female patients undergoing breast cancer or gynecologic surgery, [15][16][17][18] and the other 10 studies included surgical procedures for both male and female patients. [19][20][21][22][23][24][25][26][27][28] In the control group, 6 studies used fentanyl alone, and the remaining 8 mostly combinedremifentanil, sufentanil, or morphine. In the opioid-free group, 6 non-opioid analgesics, including dexmedetomidine, ketamine, magnesium, lidocaine, ketorolac, and clonidine, as well as local nerve blocks, were used in 1 trial with anesthesia using inhaled isoflurane under nerve block to maintain spontaneous breathing, while the other 13 studies used two or more drugs or combined local nerve blocks instead of opioids.…”

Is Continuous Wound Infiltration a Better Option for Postoperative Pain Management after Open Nephrectomy Compared to Thoracic Epidural Analgesia?

“…However, the mean induction time was 12 min shorter in the CWI than in the TEA group (24 min. [IQR [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] vs. 36 min. [IQR 28-52]; p = 0.001).…”

“…Nevertheless, the use of CWI versus TEA for lumbotomy should also be addressed in a RCT before a definitive conclusion can be drawn. The increases in opioid consumption in the CWI group should be further addressed with other components of multimodal analgesia techniques, such as the use of intraoperative Dexmedetomidine infusions, for example [28].…”

Low opioid and opioid-free anesthesia - a review of current data

“…The incidence of postoperative nausea and vomiting was also not significantly different. [24] A hysteroscopy procedure was performed on 90 patients. Lidocaine was administered in half of them, and sufentanyl in the other half.…”