Perioperative Opioid Administration

Shanthanna, Harsha; Ladha, Karim; Kehlet, Henrik; Joshi, Girish P.

doi:10.1097/aln.0000000000003572

Cited by 168 publications

(142 citation statements)

References 154 publications

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“…Preventive MgSO 4 reduced total opioid consumption up to 48 h after surgery in the current study, which is consistent with prior reports but of greater magnitude (33%) [19]. In particular, due to this opioid-sparing effect, MgSO 4 has more recently been proposed as one component in different multimodal analgesic concepts in the context of opioid-free anesthesia [20]. We showed clinical utility in combination with MgSO 4 , which opioids alone cannot, to manage intraoperative nociception and postoperative pain.…”

Section: Discussionsupporting

confidence: 91%

Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery, Which Can Not Be Achieved with Opioid-Only Protocol: A Randomized Double-Blind Placebo-Controlled Study

Sohn

Kim

Bae

et al. 2021

JCM

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Spine surgery is painful despite the balanced techniques including intraoperative and postoperative opioids use. We investigated the effect of intraoperative magnesium sulfate (MgSO4) on acute pain intensity, analgesic consumption and intraoperative neurophysiological monitoring (IOM) during spine surgery. Seventy-two patients were randomly allocated to two groups: the Mg group or the control group. The pain intensity was significantly alleviated in the Mg group at 24 h (3.2 ± 1.7 vs. 4.4 ± 1.8, p = 0.009) and 48 h (3.0 ± 1.2 vs. 3.8 ± 1.6, p = 0.018) after surgery compared to the control group. Total opioid consumption was reduced by 30% in the Mg group during the same period (p = 0.024 and 0.038, respectively). Patients in the Mg group required less additional doses of rocuronium (0 vs. 6 doses, p = 0.025). Adequate IOM recordings were successfully obtained for all patients, and abnormal IOM results denoting warning criteria (amplitude decrement >50%) were similar. Total intravenous anesthesia with MgSO4 combined with opioid-based conventional pain control enables intraoperative patient immobilization without the need for additional neuromuscular blocking drugs and reduces pain intensity and analgesic requirements for 48 h after spine surgery, which is not achieved with only opioid-based protocol.

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Section: Discussionsupporting

confidence: 91%

Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery, Which Can Not Be Achieved with Opioid-Only Protocol: A Randomized Double-Blind Placebo-Controlled Study

Sohn

Kim

Bae

et al. 2021

JCM

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“…Han and colleagues reported that the intraoperative administration of a loading dose of dexmedetomidine (1 μg kg -1 ) combined with sevoflurane (compared to the use of propofol) led to significant stability in blood pressure during the operative period [ 32 ]. When compared with systemic agents, regional blockade is most effective for controlling movement-evoked pain [ 33 ]. TPVB not only causes dense somatic afferent blockades, but also completely blocks transmission within the sympathetic chain (due to the anatomy of the paravertebral space).…”

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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“…Among available opioid-sparing agents, loco-regional blocks perhaps have the greatest benefits, whenever appropriate. This is because they can be selectively applied to a particular area of the body with no systemic side effects and they also act superiorly on pain with activity, which is functionally more important [ 45 ]. However, they are all limited by their duration of effect.…”

Section: Discussionmentioning

confidence: 99%

Cryoanalgesia for postsurgical pain relief in adults: A systematic review and meta-analysis

Park

Coomber

Gilron

et al. 2021

Annals of Medicine &Amp; Surgery

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Background Despite advances in pain management, postoperative pain continues to be an important problem with significant burden. Many current therapies have dose-limiting adverse effects and are limited by their short duration of action. This review examines the evidence for the efficacy and safety of cryoanalgesia in postoperative pain. Materials and methods This review was registered in PROSPERO and prepared in accordance with PRISMA. MEDLINE, EMBASE, and Cochrane databases were searched until July 2020. We included randomized controlled trials (RCTs) of adults evaluating perioperatively administered cryoanalgesia for postoperative pain relief. Results Twenty-four RCTS were included. Twenty studies examined cryoanalgesia for thoracotomy, two for herniorrhaphy, one for nephrectomy and one for tonsillectomy. Meta-analysis was performed for thoracic studies. We found that cryoanalgesia with opioids was more efficacious than opioid analgesia alone for acute pain (mean difference [MD] 2.32 units, 95 % confidence interval [CI] −3.35 to −1.30) and persistent pain (MD 0.81 units, 95 % CI –1.10 to −0.53) after thoracotomy. Cryoanalgesia with opioids also resulted in less postoperative nausea compared to opioid analgesia alone (relative risk [RR] 0.23, 95 % CI 0.06 to 0.95), but there was no difference in atelectasis (RR 0.38, 95 % CI 0.07 to 2.17). Conclusion Heterogeneity in comparators and outcomes were important limitations. In general, reporting of adverse events was incomplete and inconsistent. Many studies were over two decades old, and most were limited in how they described their methodology. Considering the potential, larger RCTs should be performed to better understand the role of cryoanalgesia in postoperative pain management.

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Perioperative Opioid Administration

Cited by 168 publications

References 154 publications

Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery, Which Can Not Be Achieved with Opioid-Only Protocol: A Randomized Double-Blind Placebo-Controlled Study

Magnesium Sulfate Enables Patient Immobilization during Moderate Block and Ameliorates the Pain and Analgesic Requirements in Spine Surgery, Which Can Not Be Achieved with Opioid-Only Protocol: A Randomized Double-Blind Placebo-Controlled Study

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

Cryoanalgesia for postsurgical pain relief in adults: A systematic review and meta-analysis

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