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Current Reviews in Clinical and Experimental Pharmacology

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ISSN (Print): 2772-4328
ISSN (Online): 2772-4336

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Research Article

Is Intraoperative Opioids Avoidance A Utopia? A Matched Study in Laparoscopic Hysterectomy

Author(s): Patrice Forget *, Marc De Kock, Linda Lovqvist and Fernande Lois

Volume 16, Issue 1, 2021

Published on: 02 March, 2020

Page: [103 - 108] Pages: 6

DOI: 10.2174/1574884715666200302122707

Abstract

Background: Opioid-sparing strategies are recommended, and Opioid-Free Anaesthesia (OFA) is proposed in the literature. But few data exist about the feasibility of OFA in the routine practice. From a larger series of 21,463 patients receiving OFA, this work investigates the postoperative pain and related outcomes in patients undergoing laparoscopic hysterectomy.

Materials and Methods: This matched retrospective study concerned 521 patients scheduled for a laparoscopic hysterectomy between 2010 and 2015 (118 receiving OFA and 403 receiving anaesthesia with opioids, AO). Primary outcome was pain in the Post-Anaesthetic Care Unit (PACU).

Results: Among the 521 included patients, 403 received sufentanil (mean±SD: 0.1±0.05 mcg/kg), the only synthetic opioid used to balance anaesthesia. Concerning the 118 patients receiving OFA, most of them received an association of clonidine (97%) and ketamine (95%). Most of the patients in both groups received non-steroidal anti-inflammatory drugs. No difference in pain scores was observed between AO and OFA (median [IQR], respectively: 4 [0-5] vs. 4.5 [0-6], P=0.74). A difference in the perioperative morphine equivalent use was observed (mean±SD: 0.18±0.06 mg/kg vs. 0.09±0.06 mg/kg, P<0.001). No difference was observed regarding the nausea/vomiting incidences, use of anti-emetics, sedation scores, or time spent at the PACU.

Conclusion: Coming from an extensive daily practice, these data show that OFA is feasible and not associated with higher pain scores or longer PACU stay, suggesting the absence of specific immediate complications.

Keywords: Opioid-free anaesthesia, cancer, urinary retention, pruritus, intraoperative opioids, remifentanil.

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[1]
Weber L, Yeomans DC, Tzabazis A. Opioid-induced hyperalgesia in clinical anesthesia practice: What has remained from theoretical concepts and experimental studies? Curr Opin Anaesthesiol 2017; 30(4): 458-65.
[http://dx.doi.org/10.1097/ACO.0000000000000485] [PMID: 28590258]
[2]
Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesth Analg 2008; 106(5): 1535-41.
[http://dx.doi.org/10.1213/ane.0b013e318168b2ce] [PMID: 18420872]
[3]
Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93(2): 409-17.
[http://dx.doi.org/10.1097/00000542-200008000-00019] [PMID: 10910490]
[4]
van Gulik L, Ahlers SJ, van de Garde EM, et al. Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr after sternotomy. Br J Anaesth 2012; 109(4): 616-22.
[http://dx.doi.org/10.1093/bja/aes247] [PMID: 22831889]
[5]
Joly V, Richebe P, Guignard B, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103(1): 147-55.
[http://dx.doi.org/10.1097/00000542-200507000-00022] [PMID: 15983467]
[6]
Sandkühler J, Gruber-Schoffnegger D. Hyperalgesia by synaptic Long-Term Potentiation (LTP): An update. Curr Opin Pharmacol 2012; 12(1): 18-27.
[http://dx.doi.org/10.1016/j.coph.2011.10.018] [PMID: 22078436]
[7]
Forget P, De Kock M. Could anaesthesia, analgesia and sympathetic modulation affect neoplasic recurrence after surgery? A systematic review centred over the modulation of natural killer cells activity. Ann Fr Anesth Reanim 2009; 28(9): 751-68.
[http://dx.doi.org/10.1016/j.annfar.2009.07.078] [PMID: 19717275]
[8]
Sanchez Munoz MC, De Kock M, Forget P. What is the place of clonidine in anesthesia? Systematic review and meta-analyses of randomized controlled trials. J Clin Anesth 2017; 38: 140-53.
[http://dx.doi.org/10.1016/j.jclinane.2017.02.003] [PMID: 28372656]
[9]
Forget P, Cata J. Stable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials. Best Pract Res Clin Anaesthesiol 2017; 31(4): 523-31.
[http://dx.doi.org/10.1016/j.bpa.2017.07.001] [PMID: 29739541]
[10]
de Boer HD, Detriche O, Forget P. Opioid-related side effects: Postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Pract Res Clin Anaesthesiol 2017; 31(4): 499-504.
[http://dx.doi.org/10.1016/j.bpa.2017.07.002] [PMID: 29739538]
[11]
Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand 2000; 45(7): 795-804.

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