The Benefits of Opioid Free Anesthesia and the Precautions Necessary When Employing It

Abstract

The use of opioids in the perioperative period is associated with respiratory depression, impaired gastrointestinal function, post-operative nausea and vomiting (PONV), pruritus, urinary retention, delirium and the potential for developing opioid addiction. Currently the United States is experiencing an epidemic of prescription opioid abuse and deaths from overdose. Many addicts develop their addiction during a routine surgical admission to hospital. More people now die from overdose of synthetic prescription opioids than from heroin and other street drugs. Public education campaigns teaching family members of addicts to reverse opioid induced respiratory depression with naloxone are currently underway. Preventing the development of addiction in the first place during and after the surgical admission however will be more successful at saving lives. Primary prevention of opioid addiction is possible when non-opioid analgesic drugs are used. Employing alternative analgesic drugs in the peri-operative period that have a lower addiction potential and less respiratory depression has therefore become a matter of great national importance. Many powerful non-opioid analgesics are currently available that have more favorable side effect profiles and a lower potential for developing addiction. However, these medications are currently not used as often in routine clinical practice as they should be. Replacing opioids with other analgesics will not only reduce the development of opioid addiction but will also lead to better perioperative outcomes and enhanced patient recovery. This article briefly reviews the opioid alternatives that can significantly reduce or even entirely eliminate the perioperative use of opioids in the majority of surgical procedures.

A Comparison of Femoropopliteal Block versus Spinal Anesthesia for Malleolar Surgeries

“…Opioids can cause constipation, urinary retention, respiratory depression along with possibility of dependence and addiction and hyperalgesia. 4 Thus, we arrive at a point where we need to devise newer techniques and drugs for the control of pain. Peripheral nerve blocks have always been used either as sole anesthetic technique or along with general anesthesia.…”

Outcomes for 41 260 pediatric surgical patients with opioid‐free anesthesia: One center's experience

“…Effective regional anesthesia and multimodal non‐opioid analgesic strategies are major components of enhanced recovery after surgery pathways that reduce opioid utilization and improve outcomes 16–18 . Many of these non‐opioid analgesics are associated with specific benefits and side effects 19 .…”

“…15 Effective regional anesthesia and multimodal non-opioid analgesic strategies are major components of enhanced recovery after surgery pathways that reduce opioid utilization and improve outcomes. [16][17][18] Many of these non-opioid analgesics are associated with specific benefits and side effects. 19 For example, dexmedetomidine produces stress response ablation and sedation without respiratory depression but can cause bradycardia.…”

Opioid-free Anesthesia Protocol on the Early Quality of Recovery after Major Surgery (SOFA Trial): A Randomized Clinical Trial

“…However, existing literature on OFA remains contentious. [11][12][13][14] The most rigorously designed randomized controlled trial to date was halted prematurely due to adverse events in the OFA group. 15 In that study, patients undergoing major noncardiac surgeries were administered balanced anesthesia with either remifentanil or dexmedetomidine infusions.…”