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Current Medicinal Chemistry

Author(s): Alfredo Malo-Manso*, Ana Fontaneda-Heredia, Salvador Romero-Molina, Enrique Sepúlveda-Haro, Juan José Escalona-Belmonte and José Luis Guerrero-Orriach

DOI: 10.2174/0929867329666220907155612

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Opioid-Free Anaesthesia Improves Anaesthesia Recovery when Compared with that of Opioid-Based Anaesthesia. Systematic Review and Meta-Analysis of Clinical Trials

Page: [1667 - 1681] Pages: 15

  • * (Excluding Mailing and Handling)

Abstract

Introduction: Opioid Free Anesthesia (OFA) is a relatively new technique that has been questioned due to the lack of evidence regarding its benefit-risk balance.

Methods: Four international databases were searched for clinical trials comparing OFA with opioid based anesthesia. The primary outcome was pain control and the secondary included postoperative nausea and vomiting (PONV), gastrointestinal recovery, respiratory depression, urinary retention, length of hospital stay, surgical complications, number of patients with cessation of the intervention and other side effects.

Results: Pain was better controlled in the OFA group in all the measurements made (VAS 1h: Md = -0.81, CI95% = -0.48- -1.14, VAS 24h: Md = -1.25, CI95% =-2.41- -0.1, VAS >24h: Md = -1.36, CI95% = -1.73- -1). In the opioid group there was an increase in the risk of nausea (RR=2.69, CI95% = 2-3.61) and vomiting (RR = 3.99, CI95% = 2.06-7.74), whilst in the OFA group, there was an increased risk of bradycardia (RR= 1.62, CI95% = 1.02-2.57). The rest of the variables showed no differences between groups or could not be analyzed.

Conclusion: There is a clear benefit of OFA in pain control and PONV, but there is also a higher risk of bradycardia. This technique should be considered in patients with a special risk of difficult postoperative pain control or PONV. However, the best drug combination to perform OFA is still unknown, as well as the type of patient that benefits more with less risk.

Keywords: opioids, anesthesia, OFA, lidocain, propofol, dexmedetomidine

[1]
Mulier, J. Opioid free general anesthesia: A paradigm shift? Rev. Esp. Anestesiol. Reanim., 2017, 64(8), 427-430.
[http://dx.doi.org/10.1016/j.redar.2017.03.004] [PMID: 28431750]
[2]
Benyamin, R.; Trescot, A.M.; Datta, S.; Buenaventura, R.; Adlaka, R.; Sehgal, N.; Glaser, S.E.; Vallejo, R. Opioid complications and side effects. Pain Physician, 2008, 2s, S105-S120.
[http://dx.doi.org/10.36076/ppj.2008/11/S105] [PMID: 18443635]
[3]
Buvanendran, A.; Kroin, J.S. Multimodal analgesia for controlling acute postoperative pain. Curr. Opin. Anaesthesiol., 2009, 22(5), 588-593.
[http://dx.doi.org/10.1097/ACO.0b013e328330373a] [PMID: 19606021]
[4]
Jessen Lundorf, L.; Korvenius Nedergaard, H.; Møller, A.M. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Libr., 2016, 2, CD010358.
[http://dx.doi.org/10.1002/14651858.CD010358.pub2] [PMID: 26889627]
[5]
Brinck, E.; Tiippana, E.; Heesen, M.; Bell, R.F.; Straube, S.; Moore, R.A.; Kontinen, V. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Libr., 2018, 12(12), CD012033.
[http://dx.doi.org/10.1002/14651858.CD012033.pub4] [PMID: 30570761]
[6]
Bailey, M.; Corcoran, T.; Schug, S.; Toner, A. Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: A systematic review and meta-analysis of efficacy and safety. Pain, 2018, 159(9), 1696-1704.
[http://dx.doi.org/10.1097/j.pain.0000000000001273] [PMID: 29757886]
[7]
Gelineau, A.M.; King, M.R.; Ladha, K.S.; Burns, S.M.; Houle, T.; Anderson, T.A. Intraoperative esmolol as an adjunct for perioperative opioid and postoperative pain reduction. Anesth. Analg., 2018, 126(3), 1035-1049.
[http://dx.doi.org/10.1213/ANE.0000000000002469] [PMID: 29028742]
[8]
Greenwood, J.; Nygard, B.; Brickey, D. Effectiveness of intravenous magnesium sulfate to attenuate hemodynamic changes in laparoscopic surgery: A systematic review and meta-analysis. JBI Evid. Synth., 2021, 19(3), 578-603.
[http://dx.doi.org/10.11124/JBISRIR-D-19-00414] [PMID: 33074990]
[9]
Mulier, J.P.; Dillemans, B. Anaesthetic factors affecting outcome after bariatric surgery, a retrospective levelled regression analysis. Obes. Surg., 2019, 29(6), 1841-1850.
[http://dx.doi.org/10.1007/s11695-019-03763-1] [PMID: 30879241]
[10]
King, C.A.; Perez-Alvarez, I.M.; Bartholomew, A.J.; Bozzuto, L.; Griffith, K.; Sosin, M.; Thibodeau, R.; Gopwani, S.; Myers, J.; Fan, K.L.; Tousimis, E.A. Opioid-free anesthesia for patients undergoing mastectomy: A matched comparison. Breast J., 2020, 26(9), 1742-1747.
[http://dx.doi.org/10.1111/tbj.13999] [PMID: 32767477]
[11]
Enten, G.; Shenouda, M.A.; Samuels, D.; Fowler, N.; Balouch, M.; Camporesi, E. A retrospective analysis of the safety and efficacy of opioid-free anesthesia versus opioid anesthesia for general cesarean section. Cureus, 2019, 11(9), e5725.
[http://dx.doi.org/10.7759/cureus.5725] [PMID: 31720193]
[12]
Frauenknecht, J.; Kirkham, K.R.; Jacot-Guillarmod, A.; Albrecht, E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: A systematic review and meta-analysis. Anaesthesia, 2019, 74(5), 651-662.
[http://dx.doi.org/10.1111/anae.14582] [PMID: 30802933]
[13]
Bakan, M.; Umutoglu, T.; Topuz, U.; Uysal, H.; Bayram, M.; Kadioglu, H.; Salihoglu, Z. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: A prospective, randomized, double-blinded study. Braz. J. Anesthesiol., 2015, 65(3), 191-199.
[http://dx.doi.org/10.1016/j.bjane.2014.05.001] [PMID: 25925031]
[14]
Beloeil, H.; Garot, M.; Lebuffe, G.; Gerbaud, A.; Bila, J.; Cuvillon, P.; Dubout, E.; Oger, S.; Nadaud, J.; Becret, A.; Coullier, N.; Lecoeur, S.; Fayon, J.; Godet, T.; Mazerolles, M.; Atallah, F.; Sigaut, S.; Choinier, P.M.; Asehnoune, K.; Roquilly, A.; Chanques, G.; Esvan, M.; Futier, E.; Laviolle, B. Balanced opioid-free anesthesia with dexmedetomidine versus balanced anesthesia with remifentanil for major or intermediate noncardiac surgery. Anesthesiology, 2021, 134(4), 541-551.
[http://dx.doi.org/10.1097/ALN.0000000000003725] [PMID: 33630043]
[15]
Garg, K.; Bhardwaj, S.; Devgan, S. Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients. J. Anaesthesiol. Clin. Pharmacol., 2019, 35(4), 481-486.
[http://dx.doi.org/10.4103/joacp.JOACP_382_18] [PMID: 31920231]
[16]
Hakim, K.K.; Wahba, W.B. Opioid-free total intravenous anesthesia improves postoperative quality of recovery after ambulatory gynecologic laparoscopy. Anesth. Essays Res., 2019, 13(2), 199-203.
[http://dx.doi.org/10.4103/aer.AER_74_19] [PMID: 31198230]
[17]
Hontoir, S.; Saxena, S.; Gatto, P.; Khalife, M.; Ben Aziz, A.M.; Paesmans, M.; Sosnowski, M. Opioid-free anesthesia: What about patient comfort? A prospective, randomized, controlled trial. Acta Anaesthesiol. Belg., 2016, 67(4), 183-190.
[PMID: 29873988]
[18]
Luong, N.V.; Giang, N.T.; Chuong, H.V.; Cuong, N.M.; Dinh, N.V.; Anh, V.; Hanh, M.D.; Thuy, N.L.P.; Son, L.T.; Kien, N.T. Evaluation of efficacy of free opioid anesthesia for laparoscopic cholecystectomy: A prospective, randomized double-blinded study. Open Anesthesiol. J., 2020, 14, 73-79.
[http://dx.doi.org/10.2174/2589645802014010073]
[19]
Mulier, J.P.; Dillemans, B. A prospective randomized controlled trial comparing a multitarget opioid free anaesthesia (OFA) and a 3-liter volume calculated airseal carbon dioxide insufflator with a balanced anaesthesia using sufentanil-sevoflurane and a standard 15 mmhg carbon dioxide pressure pneumoperitoneum insufflator in a 2x2 factorial design. J. Clin. Anesth. Pain Med., 2018, 2(2), 023.
[20]
Mulier, J.P.; Wouters, R.; Dillemans, B.; Dekock, M. A randomized controlled, double-blind trial evaluating the effect of opioid-free versus opioid general anaesthesia on postoperative pain and discomfort measured by the QoR-40. J. Clin. Anesth. Pain Med., 2018, 2(1), 015.
[21]
Toleska, M.; Dimitrovski, A. Is opioid-free general anesthesia more superior for postoperative pain versus opioid general anesthesia in laparoscopic cholecystectomy? Prilozi (Makedon. Akad. Nauk. Umet. Odd. Med. Nauki), 2019, 40(2), 81-87.
[http://dx.doi.org/10.2478/prilozi-2019-0018] [PMID: 31605587]
[22]
Ziemann-Gimmel, P.; Goldfarb, A.A.; Koppman, J.; Marema, R.T. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br. J. Anaesth., 2014, 112(5), 906-911.
[http://dx.doi.org/10.1093/bja/aet551] [PMID: 24554545]
[23]
Eldin Abdel Hamid, M.H. Intravenous dexmedetomidine infusion compared with that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. Anesth. Essays Res., 2017, 11(4), 1070-1074.
[http://dx.doi.org/10.4103/aer.AER_148_17] [PMID: 29284877]
[24]
Collard, V.; Mistraletti, G.; Taqi, A.; Asenjo, J.F.; Feldman, L.S.; Fried, G.M.; Carli, F. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth. Analg., 2007, 105(5), 1255-1262.
[http://dx.doi.org/10.1213/01.ane.0000282822.07437.02] [PMID: 17959952]
[25]
Coloma, M.; Chiu, J.W.; White, P.F.; Armbruster, S.C. The use of esmolol as an alternative to remifentanil during desflurane anesthesia for fast-track outpatient gynecologic laparoscopic surgery. Anesth. Analg., 2001, 92(2), 352-357.
[http://dx.doi.org/10.1213/00000539-200102000-00014] [PMID: 11159231]
[26]
Feld, J.M.; Laurito, C.E.; Beckerman, M.; Vincent, J.; Hoffman, W.E. Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can. J. Anaesth., 2003, 50(4), 336-341.
[http://dx.doi.org/10.1007/BF03021029] [PMID: 12670809]
[27]
Feld, J.M.; Hoffman, W.E.; Stechert, M.M.; Hoffman, I.W.; Ananda, R.C. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J. Clin. Anesth., 2006, 18(1), 24-28.
[http://dx.doi.org/10.1016/j.jclinane.2005.05.009] [PMID: 16517328]
[28]
Hwang, W.; Lee, J.; Park, J.; Joo, J. Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: A randomized controlled study. BMC Anesthesiol., 2015, 15(1), 21.
[http://dx.doi.org/10.1186/s12871-015-0004-1] [PMID: 25750586]
[29]
Jung, H.S.; Joo, J.D.; Jeon, Y.S.; Lee, J.A.; Kim, D.W.; In, J.H.; Rhee, H.Y.; Choi, J.W. Comparison of an intraoperative infusion of dexmedetomidine or remifentanil on perioperative haemodynamics, hypnosis and sedation, and postoperative pain control. J. Int. Med. Res., 2011, 39(5), 1890-1899.
[http://dx.doi.org/10.1177/147323001103900533] [PMID: 22117991]
[30]
López-Álvarez, S.; Mayo-Moldes, M.; Zaballos, M.; Iglesias, B.G.; Blanco-Dávila, R. Esmolol versus ketamine-remifentanil combination for early postoperative analgesia after laparoscopic cholecystectomy: A randomized controlled trial. Can. J. Anaesth., 2012, 59(5), 442-448.
[http://dx.doi.org/10.1007/s12630-012-9684-x] [PMID: 22383085]
[31]
Mansour, M.; Mahmoud, A.A.; Geddawy, M. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study. Saudi J. Anaesth., 2013, 7(4), 387-391.
[http://dx.doi.org/10.4103/1658-354X.121045] [PMID: 24348288]
[32]
Salman, N.; Uzun, S.; Coskun, F.; Salman, M.A.; Salman, A.E.; Aypar, U. Dexmedetomidine as a substitute for remifentanil in ambulatory gynecologic laparoscopic surgery. Saudi Med. J., 2009, 30(1), 77-81.
[PMID: 19139778]
[33]
Turgut, N.; Turkmen, A.; Gökkaya, S.; Altan, A.; Hatiboglu, M.A. Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy. Minerva Anestesiol., 2008, 74(9), 469-474.
[PMID: 18762754]
[34]
Massoth, C.; Schwellenbach, J.; Saadat-Gilani, K.; Weiss, R.; Pöpping, D.; Küllmar, M.; Wenk, M. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial. J. Clin. Anesth., 2021, 75, 110437.
[http://dx.doi.org/10.1016/j.jclinane.2021.110437] [PMID: 34229292]
[35]
Aboelela, M.A.; Alrefaey, A.K. Opioid free versus opioid based anesthesia in abdominal gynecological surgery: A prospective randomized controlled trial. Apicare J., 2021, 25(5), 653-659.
[36]
Qian, X.; Yuan, H.; Zhao, L.; Feng, S.; Chen, Y.; Wang, X. Opioid-free general anesthesia with dexmedetomidine-esketamine-lidocaine versus opioid-based general anesthesia with sufentanil-remifentanil for breast benign patients undergoing lumpectomy. Res. Square, 2021, 2021, PPR401377.
[http://dx.doi.org/10.21203/rs.3.rs-900446/v1]