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Are opioids indispensable for general anaesthesia?

Talmage D Egan1

  • 1Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA.

British Journal of Anaesthesia
|May 21, 2019
PubMed
Summary

Multimodal general anesthesia aims to reduce opioid use by combining various drugs to manage surgical stress. Further research is needed to confirm if this approach improves anesthesia outcomes and reduces persistent opioid use post-surgery.

Keywords:
general anesthesiaminimum alveolar concentrationopioid epidemicopioidspersistent pain after surgery

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Pain Management

Background:

  • General anesthesia requires unconsciousness, immobility, and autonomic stability, often achieved with high drug concentrations leading to side effects.
  • Balanced anesthesia traditionally uses opioids to reduce anesthetic requirements, but the opioid epidemic necessitates alternatives.
  • Persistent opioid use after surgery is a significant concern, prompting a shift towards opioid stewardship and multimodal approaches.

Purpose of the Study:

  • To explore the concept of multimodal general anesthesia as an alternative to traditional balanced anesthesia.
  • To investigate the role of intraoperative opioid usage in persistent opioid use after surgery.
  • To highlight the need for research on the impact of multimodal anesthesia on anesthesia outcomes and opioid use.

Main Methods:

  • Review of current anesthesia concepts, including balanced and multimodal general anesthesia.
  • Discussion of the challenges in achieving anesthetic goals with single agents versus combined therapies.
  • Identification of research gaps concerning intraoperative opioid patterns and long-term opioid use.

Main Results:

  • Single anesthetic agents struggle to suppress autonomic responses without causing significant hemodynamic depression.
  • Multimodal general anesthesia incorporates adjunct drugs to target diverse neurophysiological mechanisms.
  • The link between intraoperative opioid administration and persistent postoperative opioid use remains under-researched.

Conclusions:

  • Moderating perioperative opioid use, including intraoperative administration, is a key goal.
  • The efficacy of multimodal general anesthesia in improving outcomes and reducing persistent opioid use requires further investigation.
  • Research into intraoperative opioid usage patterns is a critical priority for addressing the opioid epidemic in surgical settings.