Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options

Kianian, Sara; Bansal, Jahnvi; Lee, Christopher; Zhang, Kalissa; Bergese, Sergio D.

doi:10.1007/s44254-023-00043-1

Cited by 5 publications

References 174 publications

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Effect of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly patients with hypertension after colorectal cancer surgery

Ma,

Qu,

Chen

et al. 2024

BMC Surg

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Purpose Colorectal cancer (CRC) surgery in elderly patients with hypertension poses challenges due to potential complications and prolonged recovery. This study aimed to assess the impact of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly hypertension patients undergoing CRC surgery. Methods A total of 80 elderly hypertension patients who underwent open surgery for CRC in the People’s Hospital of Xinjiang Uygur Autonomous Region from October 2020 to October 2022 were selected and randomly divided into two group (A and B, n = 40) through the random number table method. Group A received multimodal opioid-sparing anesthesia, defined as low-dose opioid general anesthesia combined with a transversus abdominis plane block, incision infiltration with local anesthetics, and postoperative analgesia via a patient-controlled analgesia (PCA) pump, with the remifentanil dose set at one-third (± 10%) of the conventional group’s dose. Group B received conventional opioid anesthesia, involving standard general anesthesia maintained with remifentanil at 0.4–0.5 µg/(kg·min), incision infiltration with local anesthetics, and postoperative PCA. Primary outcomes included mean arterial pressure (MAP) and heart rate (HR), changes in albumin, C-reactive protein (CRP) and white blood cell (WBC), indicators of intestinal function recovery (the recovery time of bowel sounds, the first exhaust time, the first defecation time and the feeding recovery time), and visual analogue scale (VAS) pain scores. Second outcomes included postoperative complications and total hospital stays. Results After excluding 8 patients, 72 were included in the final analysis. Compared with patients in the B group, patients in the A group exhibited shorter recovery time of bowel sounds, first exhaust time and feeding recovery time ( P < 0.05), higher levels of postoperative albumin, and lower levels of CRP and WBC ( P < 0.05). Moreover, the incidence of nausea and vomiting was lower and the total hospital stays were fewer in the A group than in the B group ( P < 0.05). Conclusion Multimodal opioid-sparing anesthesia contributes to rapid recovery of postoperative intestinal function and reduction of postoperative adverse reactions. Therefore, it is safe and feasible to apply multimodal opioid-sparing anesthesia to elderly hypertension patients receiving open surgery for CRC.

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Effect of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly patients with hypertension after colorectal cancer surgery

Ma,

Qu,

Chen

et al. 2024

BMC Surg

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Efficacy and Safety of Various Intravenous Lidocaine Infusion Doses Combined with Ropivacaine for Transversus Abdominis Plane Block in Pain Management for Elderly Patients undergoing Colorectal Cancer Surgery: a pilot study

Yu,

Xu,

Tang

et al. 2024

Preprint

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Background Perioperative lidocaine infusion benefits abdominal surgery patients, but the optimal dose in elderly patients remains unclear. While Transversus Abdominis Plane (TAP) block is a recognized analgesic method, its combination with lidocaine infusion in elderly patients needs further investigation. This study aims to assess the impact and safety of different lidocaine infusion doses combined with ropivacaine TAP block on postoperative analgesia in elderly patients undergoing colorectal cancer resection.Methods Patients (n = 55 per group) were randomized into four groups. After a preoperative 0.25% ropivacaine bilateral TAP block, patients received perioperative 1% lidocaine at 0.5, 1.0, or 1.5 mg/kg/h, or normal saline (placebo). Postoperatively, lidocaine groups used PCIA devices delivering lidocaine at 0.3–1.5 mg/kg/h for 72 hours; the placebo group received saline. The primary outcome was the incidence of moderate-to-severe pain during activity 24 hours postoperatively. Secondary outcomes included pain during movement and at rest over three days, quality of recovery, bowel function recovery time, postoperative morphine use, and adverse events related to opioids and local anesthetics. Plasma lidocaine levels were measured post-surgery and at 24 hours.Results The lidocaine 1.5 group had a significantly lower incidence of moderate-to-severe postoperative pain during movement compared to the control group at 24 hours (38.2% vs. 65.5%, Bonferroni corrected P = 0.004). No significant differences were observed in the lidocaine 1.0 or 0.5 groups. Other outcomes, including postoperative quality of recovery, morphine consumption, bowel function recovery time, and adverse reactions to opioids, were similar across groups (all P > 0.05). Only one instance of plasma lidocaine concentration exceeding 4.0 µg/ml was observed, with no serious adverse events.Conclusions For elderly patients, a 1.5 mg/kg/h lidocaine infusion may be safer and more effective, serving as a cornerstone for future research.Trial registration: Registered 25 May 2022—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/results?term=NCT05412576

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Opioid−free anesthesia attenuates perioperative immunosuppression by regulating macrophages polarization in gastric cancer patients treated with neoadjuvant PD-1 inhibitor

Liu,

Ou,

Xue

et al. 2024

Front. Immunol.

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BackgroundOpioid anesthesia can modulate the impaired immune response and opioid-sparing anesthesia may preserve immune functions. This study was performed to assess the effects of opioid-free anesthesia (OFA) and opioid-based anesthesia (OA) on perioperative macrophages differentiation, cytokine changes, and perioperative complications in locally advanced GC (LAGC) patients.MethodsWe used quality of recovery-15 (QoR-15) questionnaire scores and visual analog scale (VAS) scores to compare postoperative quality of recovery and pain level. In addition, the adverse reactions of patients in the two groups were compared. The perioperative serum level of inflammatory cytokines and the ratio of macrophage subtypes were detected.ResultsThe OFA group had significantly longer extubation time and PACU stay, whereas the OA group had significantly higher rate of hypotension, higher doses of norepinephrine, higher PONV and dizziness rate, and delayed flatus passage time. The QoR-15 score on postoperative 24 h was significantly higher in OFA group than in OA group. At the end of or after the surgery, the OFA group had higher levels of interleukin (IL)-12, IL-1β, tumor necrosis factor (TNF)-α, CD68+CD163− macrophage rate, but lower levels of IL-10, transforming growth factor (TGF)-β, and CD68+CD163+ macrophage rate, indicating OFA attenuated perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization. And the reversal tendency is more obvious in LAGC patients with neoadjuvant PD-1 inhibitor.ConclusionsThe OFA may attenuate perioperative immunosuppression by diminishing M2 and promoting M1 macrophage polarization in LAGC patients with neoadjuvant PD-1 inhibitor.Clinical trial registrationhttp://gcpgl.sysucc.org.cn, identifier 2022-FXY-001.

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Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options

Cited by 5 publications

References 174 publications

Effect of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly patients with hypertension after colorectal cancer surgery

Effect of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly patients with hypertension after colorectal cancer surgery

Efficacy and Safety of Various Intravenous Lidocaine Infusion Doses Combined with Ropivacaine for Transversus Abdominis Plane Block in Pain Management for Elderly Patients undergoing Colorectal Cancer Surgery: a pilot study

Opioid−free anesthesia attenuates perioperative immunosuppression by regulating macrophages polarization in gastric cancer patients treated with neoadjuvant PD-1 inhibitor

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