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

D’Amico, Filippo; Barucco, Gaia; Licheri, Margherita; Valsecchi, G.; Zaraca, Luisa; Mucchetti, Marta; Zangrillo, Alberto; Monaco, Fabrizio

doi:10.3390/jcm11236955

Cited by 11 publications

(5 citation statements)

References 32 publications

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“…No significant differences were observed in NRS scores and rescue analgesia rates between the two groups at the same time after surgery. The pain scores were consistent with a recent meta-analysis by D'Amico that found no difference in pain scores between OFA and OA at 24 h after thoracic surgery (MD -1.69 [-3.82,0.43]; P = 0.12) (28). The NRS was the highest at 6 h after surgery due to the weakening of the analgesic effect of the intercostal nerve block and the stimulation of the pleura by the thoracic drainage tube.…”

Section: Discussionsupporting

confidence: 90%

Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial

et al. 2023

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BackgroundOpioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery.MethodsSixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward.ResultsThere was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (P=0.001) and a lower incidence of hypotension (P=0.004) during surgery. The OFA group resumed spontaneous respiration faster (P<0.001) and had a higher quality of lung collapse (P=0.02). However, the total doses of propofol and dexmetomidine were higher (P=0.03 and P=0.02), and the time to consciousness was longer (P=0.039) in the OFA group.ConclusionsOFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS.

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Section: Discussionsupporting

confidence: 90%

Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial

et al. 2023

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“…Regarding the use of opioid drugs, the existing studies demonstrate contradictory evidence [24,25] .…”

Section: Discussionmentioning

confidence: 99%

Machine learning-based models predict postoperative cardiovascular and neurological complications after pneumonectomy: A 10-year retrospective observational study

Wang,

Xie,

Liu

et al. 2024

Preprint

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Background Reducing postoperative cardiovascular and neurological complications (PCNC) in thoracic surgery is key for improving postoperative survival. Therefore, we aimed to investigate the independent predictors of PCNC, develop machine learning models, and construct a predictive nomogram for PCNC in patients undergoing thoracic surgery for lung cancer. Methods This study used data from a previous retrospective study of 16,368 lung cancer patients with American Standards Association physical status I-IV who underwent surgery. Postoperative information was collected from electronic medical records; the optimal model was analyzed and filtered using multiple machine learning models (Logistic regression, eXtreme Gradient Boosting, Random Forest, Light Gradient Boosting Machine, and Naïve Bayes). The predictive nomogram was built, and the efficacy, accuracy, discriminatory power, and clinical validity were assessed using receiver operator characteristics, calibration curves, and decision curve analysis. Results Multivariate logistic regression analysis showed that age, duration of surgery, intraoperative intercostal nerve block, postoperative patient-controlled analgesia, bronchial blocker, and sufentanil were independent predictors of PCNC. Random forest was identified as the optimal model with an area under the curve of 0.898 in the training set and 0.752 in the validation set, confirming the excellent prediction accuracy of the nomogram. All the net benefits of five machine learning models in the training and validation sets demonstrated excellent clinical applicability, and calibration curves also showed good agreement between the predicted and observed risks. Conclusion The combination of machine learning models and nomograms may contribute to the early prediction and reduction of the incidence of PCNC.

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“…By using a multimodal nonopioid approach to anesthesia and perioperative analgesia, patients are able to avoid opioids altogether with either similar or improved outcomes compared to standard opioid analgesia [ 30 – 32 ]. A meta-analysis by D’Amico and colleagues examined the use of OFA in thoracic surgery and concluded that it was associated with lower rates of complications, lower pain scales and lower morphine consumption postoperatively [ 33 ]. While it remains to be seen how this could be utilized in patients with chronic opioid use and OUD, its effectiveness in decreasing perioperative opioid use may be an important method of harm reduction in the future.…”

Section: Discussionmentioning

confidence: 99%

Surgeons’ knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons

Burgess,

Heneghan,

Barot

et al. 2024

Patient Saf Surg

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Background Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care. Methods This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association’s electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons’ management of perioperative pain in patients with opioid use disorder and perceived barriers in treatment. Results A total of 260 surgeons responded representing all specialties except ophthalmology. General surgery (66.5%) and plastic and reconstructive surgery (7.5%) represented the majority of responders. Ninety-five percent of surgeons reported treating a patient who used opioids in the past month and 86% encountered a patient with OUD. Nearly half (46%) reported being uncomfortable managing postoperative pain in patients with OUD. Most (67%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons, analyses identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes. Conclusion Nearly half of surgeons report discomfort caring for patients with OUD with the vast majority involving a consulting service to assist with their care. Most surgeons believe that it would be helpful to have guidelines regarding the care of these patients. This provides an opportunity for increased education and training on the perioperative management of patients with OUD and further collaboration with addiction medicine, psychiatry and pain management colleagues.

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

Cited by 11 publications

References 32 publications

Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial

Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial

Machine learning-based models predict postoperative cardiovascular and neurological complications after pneumonectomy: A 10-year retrospective observational study

Surgeons’ knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons

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