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Published on: May 26, 2023
Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial
Carlos A B da Silveira1, Ana C D Rasador2, Heitor J S Medeiros3
1Dignity Health St. Joseph's Hospital, Phoenix, AZ, USA.
Purpose:
Opioid anesthesia is commonly employed in minimally invasive surgeries but is associated with adverse effects, including postoperative nausea and vomiting (PONV). Opioid-free anesthesia aims to mitigate these issues. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing opioid and opioid-free anesthesia in minimally invasive abdominal surgeries.
Methods:
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for randomized controlled trials (RCTs) comparing these approaches. Our primary outcomes were adverse effects (PONV, bradycardia), while secondary outcomes were pain, opioid consumption, and postanesthesia care unit (PACU) length of stay (LOS). We performed a TSA to investigate the conclusiveness of the results.
Results:
We included 26 RCTs encompassing 2,025 patients, with 1,009 (49%) in the opioid-free anesthesia group. Opioid-free anesthesia reduced PONV significantly (risk ratio, 0.55; 95% confidence interval [CI], 0.40 to 0.74; P < 0.001), but we found no significant differences in bradycardia rates. We found nonclinically relevant higher pain scores for opioid anesthesia (mean difference [MD], -0.9; 95% CI, -1.7 to -0.2; P = 0.01) and opioid consumption at 2 hr post surgery (MD, -5.4 mg oral morphine equivalents; 95% CI, -9.1 to -1.8; P = 0.004). We also noted a reduced time to first analgesia (MD, 88 min; 95% CI, 18 to 159; P = 0.01). We found no differences in PACU LOS. The TSA confirmed the sample size's adequacy in showing PONV reduction with opioid-free anesthesia.
Conclusion:
Opioid-free anesthesia showed a significant reduction in PONV and a decrease in opioid consumption during the first 2 hr postoperatively, suggesting it can be an alternative to opioid anesthesia in minimally invasive abdominal surgeries.
Study Registration:
PROSPERO ( CRD42023492385 ); first submitted 18 December 2023.
Insights
Opioid-free anesthesia significantly reduces postoperative nausea and vomiting (PONV) and opioid consumption in minimally invasive abdominal surgeries. This approach offers a viable alternative to traditional opioid anesthesia, improving patient outcomes.
Area of Science:
- Anesthesiology
- Surgical Oncology
- Pharmacology
Background:
- Opioid anesthesia is standard for minimally invasive surgeries but causes side effects like postoperative nausea and vomiting (PONV).
- Opioid-free anesthesia is explored as a strategy to reduce these adverse events.
- This study focuses on minimally invasive abdominal surgeries.
Purpose of the Study:
- To systematically review, meta-analyze, and trial sequential analyze (TSA) the efficacy of opioid-free anesthesia versus opioid anesthesia.
- To compare primary outcomes including PONV and bradycardia.
- To evaluate secondary outcomes such as pain, opioid consumption, and postanesthesia care unit (PACU) length of stay (LOS).
Main Methods:
- Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched major databases: Cochrane Central Register of Controlled Trials, MEDLINE, and Embase.
- Utilized Trial Sequential Analysis (TSA) to assess the certainty of evidence for key outcomes.
Main Results:
- Included 26 RCTs with 2,025 patients; 49% received opioid-free anesthesia.
- Opioid-free anesthesia significantly reduced PONV (RR 0.55, P < 0.001) and intraoperative opioid consumption.
- No significant difference in bradycardia or PACU LOS; opioid-free anesthesia showed a trend towards lower pain scores and reduced time to first analgesia.
Conclusions:
- Opioid-free anesthesia is effective in reducing PONV and early postoperative opioid requirements in minimally invasive abdominal surgery.
- This approach presents a safe and effective alternative to traditional opioid-based anesthesia.
- TSA confirmed adequate sample size for PONV reduction findings.
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