Opioid-free anaesthesia is both safe and effective, and dramatically decreases postoperative nausea, according to results of a retrospective review presented October 23 at the 2017 Annual Meeting of the American Society of Anesthesiologists (ASA).
Lead author Enrico M. Camporesi, MD, University of South Florida and TEAMHealth Anesthesia, Tampa, Florida and colleagues examined the records of 1,009 patients who underwent head and neck surgery with 19 surgeons — including laryngoscopy, facial plastic surgery, middle-ear surgery, and nasal or sinus surgery — working with a single anaesthesiologist at an outpatient surgery centre.
All patients underwent opioid-free anesthesia, with these protocols:
• Adult patients received 1,000 mg of acetaminophen; paediatric patients received 10 to 15 mg/kg per rectum
• If patients had obstructive sleep apnoea, they received intravenous (IV) acetaminophen
• All patients received magnesium 60mg/kg, while patients over the age of 65 or who had kidney disease received 30 mg/kg; ketamine (0.3 mg/kg) and lidocaine (1.5 mg/kg) were also administered
• Adult patients received 30 mg ketorolac, if allowed by surgeon
• Patients undergoing middle-ear surgery received oral gabapentin (300 mg)
• All patients received dexamethasone and ondansetron, as well as supplemental fluoromethyl.
Only about one-third (36%) of patients requested opioids in the post-anaesthesia care unit.
In addition, approximately 11% of patients experienced nausea after surgery, compared with the 50% to 80% of patients who typically experience nausea. Patients who undergo certain procedures, such as complex facial plastic surgery and nasal/sinus surgeries, were more likely to require pain and nausea medications.
Both patients and surgeons expressed satisfaction with this anaesthesia protocol; postoperative pain was well tolerated.
Dr. Camporesi and his colleagues noted that the traditional use of fentanyl in general anaesthesia can cause increased sensitivity to pain, which means that those patients may request more opioids during recovery. The researchers suggested that not using fentanyl during surgery, and providing patients with fewer opioids after surgery could help lower the likelihood of opioid abuse.
Three of the 19 surgeons participating in the study now prescribe just 15 hydrocodone pills for any breakthrough pain after surgery, the authors noted, compared with 50 previously — adding up to 27,000 fewer prescribed hydrocodone pills in a year.
Typical practice has been to include opioids, such as fentanyl, in combination with other medications given to patients for general anaesthesia.
[Presentation title: Post-Operative Analgesia Requirements in 1,009 Consecutive Patients Receiving Opioid-Free Anesthesia. Abstract #: A3078]