Opioid free anesthesia: evidence for short and long-term outcome

Bugada, Dario; Lorini, Luca; Lavand’homme, Patricia

doi:10.23736/s0375-9393.20.14515-2

Cited by 55 publications

(51 citation statements)

References 62 publications

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“…Tripathy and colleagues [ 25 ] found that patients undergoing magnetic resonance imaging with axillary dissection for breast cancer achieved superior analgesia with opioid-free pectoral nerve block-based anesthesia that involved dexmedetomidine, propofol, and isoflurane. We utilized a specific OFA protocol that included dexmedetomidine, sevoflurane and TPVB to replace opioids [ 26 ]. Dexmedetomidine is a highly, potent, selective αlpha 2‐adrenergic agonist with intrinsic analgesic properties that can last for at least 12 h after surgery.…”

Section: Discussionmentioning

confidence: 99%

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

Zhang

Chen

et al. 2021

PLoS ONE

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Background Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. Methods Patients (ASA Ⅰ-Ⅱ, 18–65 years old, BMI <30 kg m−2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD‑I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. Results One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). Conclusions This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study’s limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

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Section: Discussionmentioning

confidence: 99%

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

Zhang

Chen

et al. 2021

PLoS ONE

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“…Education of prescribers has been reported in Australia and New Zealand as one of the main opioid stewardship measures (78%) currently implemented. Furthermore, increased education on the use of opioid-free anesthesia and personalised opioid prescribing may have a large potential to reduce opioid use and its related adverse events [ 15 , 16 , 17 ]. Ensuring hospitals have a policy on prescriber education for safe opioid prescribing would assist in minimising such variations of opioid prescribing being observed around the world.…”

Section: Discussionmentioning

confidence: 99%

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

et al. 2021

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Objective: The objectives of this study are to describe opioid stewardship practices in hospitals being implemented globally, in addition to investigating the attitudes and perceptions of health professionals regarding opioid stewardship in the hospital setting. Methods: A survey was developed by the research team to ask about participants’ attitudes and perceptions regarding opioid stewardship practices. The survey was piloted for performance by five independent third-party healthcare professionals prior to being made available online, being hosted using Research Electronic Data Capture software, with invitations distributed by the International Pharmaceutical Federation (FIP). Descriptive analyses were used to describe the features of the study, and responses obtained from the survey were further categorised into subgroups separating answers relating to attitudes and perceptions, and policies and regulations. Results: Overall, there were 50 respondents from 18 countries, representing an 8% response rate from the FIP hospital pharmacy section mailing list. In total, 33/50 (66%) participants agreed opioids are overused nationally, with 22/49 (45%) agreeing they are overused at their workplace. Furthermore, 32/50 (64%) agreed the opioid crisis is a significant problem nationally, and 44/50 (88%) agreed opioid stewardship would reduce problems associated with the opioid crisis. Policies to educate providers about safe opioid prescribing were uncommon, not exhibited in 26/46 (57%) of hospitals, with all EMR and SE Asia hospitals not displaying this policy. Policy for investigation of narcotic discrepancies was present in 34/46 (74%) of hospitals, and there was a policy for reporting discrepancies at 33/46 (72%) hospitals. Conclusion: In conclusion, healthcare professionals in the American region are more likely to perceive the opioid crisis as a problem, as opposed to those from the European region. Regardless of the presence or absence of a crisis, the implementation of further opioid education and stewardship practices are necessary globally and will contribute to safer prescribing and utilisation practices in hospitals.

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“…Volatile anesthetics and other hypnotics used to induce and maintain general anesthesia have several anti-inflammatory and immunomodulatory effects ( 2 , 24 – 30 ). Regional anesthetic techniques, ranging from peripheral nerve blocks to neuraxial analgesia, are already employed in many primary tumor resections in order to reduce post-surgical pain and decrease opioid consumption ( 31 – 35 ). From a physiologic point of view, it is logical that one would expect an improvement in recurrence or conversion outcomes, owed to the powerful sympatholytic effects of regional anesthesia in addition to avoidance of the potentially detrimental immunosuppressive effects of volatile anesthetics and opioids.…”

Section: Use Of General Anesthesia Vs Regional Anesthesiamentioning

confidence: 99%

Anesthesia and Cancer, Friend or Foe? A Narrative Review

Montejano

Jevtović-Todorović

2021

Front. Oncol.

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Cancer remains the leading cause of death worldwide with close to 10 million deaths reported annually. Due to growth of the advanced age cohort in our population, it is predicted that the number of new cancer cases diagnosed between now until 2035 is to reach potentially 24 million individuals, a staggering increase in a relatively short time period. For many solid tumors, surgical resection along with chemotherapy is the best available approach to a potential cure which leads to almost 80% of cancer patients undergoing at least one surgical procedure during the course of their disease. During surgical intervention, the exposure to general anesthesia can be lengthy, complex and often involves various modalities resulting in an important question as to the role, if any, anesthesia may play in primary recurrence or metastatic conversion. Many components of the stress and inflammatory responses exhibited in the perioperative period can contribute to cancer growth and invasion. The agents used to induce and maintain general anesthesia have variable interactions with the immune and neuroendocrine systems and can influence the stress response during surgery. Thus, debating the best type of anesthesia that would help to attenuate sympathetic and/or pro-inflammatory responses while modulating cytokine release and transcription factors/oncogenes remains at the forefront. This may affect inducible cancer cell survival and migratory abilities not only intra-operatively, but also during the immediate post-operative phase of recovery. The ultimate question becomes how and whether the choice of anesthesia may influence the outcomes of cancer surgery with two major approaches being considered, i.e., regional and general anesthesia as well as the various hypnotics, analgesics and sympatholytics commonly used. In this review, we will address the latest information as to the role that anesthesia may play during cancer surgery with specific focus on primary recurrence and metastasis.

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Opioid free anesthesia: evidence for short and long-term outcome

Cited by 55 publications

References 62 publications

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

Anesthesia and Cancer, Friend or Foe? A Narrative Review

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