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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Impact of Opioid-free Anesthesia After Video-assisted Thoracic Surgery: A Propensity Score Study
Jean Selim1, Xavier Jarlier2, Thomas Clavier3
1Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France; Normandy Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France.
Background:
Adequate postoperative morphine consumption and pain management after thoracic surgery are major issues in the prevention of respiratory complications. Opioid-free anesthesia (OFA) may decrease morphine consumption and postoperative pain. The objective of this study was to evaluate the impact of OFA on the consumption of morphine and pain after video-assisted thoracic surgery or robotic-assisted thoracic surgery.
Methods:
The main objective of this retrospective study with propensity score analysis (PSA) was to compare the cumulative postoperative morphine consumption at 48 hours between an OFA group receiving dexmedetomidine, lidocaine, and ketamine; and an opioid anesthesia (OA) group receiving remifentanil plus morphine. Postoperative pain at 24 and 48 hours and respiratory and hemodynamics complications were also assessed.
Results:
Eighty-one patients were included, 48 in the OFA group and 33 in the OA group. The cumulative postoperative morphine consumption at 48 hours was lower in the OFA group than in the OA group (28.5 mg [0 to 62.25 mg] vs 55 mg [34 to 79.5 mg], P = .002, with PSA; OFA -27.67 mg [-46 mg to -11.5 mg], P = .002). The postoperative pain score was significantly lower in the OFA group compared with the OA group at 24 hours (2 [0 to 4] vs 3 [2 to 5], P = .064, with PSA; OFA -1.40 [-2.47 to -0.33], P = .0088) and 48 hours (0 [0 to 3] vs 2.5 [0 to 5], P = .034, with PSA; OFA -1.87 [-3.45 to -0.28], P = .021). There were no differences between groups concerning respiratory or hemodynamic complications.
Conclusions:
Our results suggest that OFA after video-assisted thoracic surgery or robotic-assisted thoracic surgery is safe and is associated with less postoperative morphine cumulative consumption and pain at 48 hours.
Insights
Opioid-free anesthesia (OFA) significantly reduces morphine use and postoperative pain following thoracic surgery. This approach is safe and effective for patients undergoing video-assisted or robotic-assisted procedures.
Area of Science:
- Anesthesiology
- Thoracic Surgery
- Pain Management
Background:
- Postoperative morphine consumption and pain are critical concerns after thoracic surgery, impacting respiratory complication prevention.
- Opioid-free anesthesia (OFA) presents a potential strategy to mitigate these issues.
Purpose of the Study:
- To evaluate the impact of OFA on morphine consumption and postoperative pain.
- To compare OFA with traditional opioid anesthesia (OA) in patients undergoing thoracic surgery.
Main Methods:
- A retrospective study utilizing propensity score analysis (PSA) compared an OFA group (dexmedetomidine, lidocaine, ketamine) with an OA group (remifentanil, morphine).
- Key outcomes included cumulative 48-hour postoperative morphine consumption, pain scores at 24 and 48 hours, and respiratory/hemodynamic complications.
Main Results:
- The OFA group demonstrated significantly lower cumulative 48-hour morphine consumption compared to the OA group (28.5 mg vs. 55 mg, P = .002 with PSA).
- Postoperative pain scores were significantly reduced in the OFA group at both 24 and 48 hours post-surgery (P = .0088 and P = .021, respectively, with PSA).
- No significant differences in respiratory or hemodynamic complications were observed between the groups.
Conclusions:
- OFA is a safe and effective anesthetic technique for video-assisted and robotic-assisted thoracic surgery.
- OFA is associated with reduced postoperative morphine consumption and pain levels.
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