Opioid Free Anaesthesia Is Feasible And Safe In Patients Undergoing Pulmonary Resection
Jason Ali, Andrew Roscoe, Chinmay Patvardhan, Guillermo Martinez, Adam Peryt, Aman Coonar, Giuseppe Aresu.
Royal Papworth Hospital, Cambridge, United Kingdom.
Introduction Intercostal thoracic surgical incisions are painful and in the postoperative period following open or thoracoscopic surgery patients typically require significant amounts of opioids to provide adequate perioperative analgesia. However, the use of opioids is commonly associated with adverse effects such as opioid-induced hyperalgesia, sedation, nausea and vomiting, and postoperative ileus. It is recognised that these complications can delay patient mobilisation and hospital discharge. We have successfully piloted the use of opioid-free anaesthesia (OFA) in patients undergoing lung cancer resection at our centre. Methods All data were recorded prospectively. The anaesthetic technique comprised induction of anaesthesia with i.v. lidocaine, propofol and non-depolarizing muscle relaxant; loco-regional analgesia (i.e. serratus anterior plane block or paravertebral block) and pre-incision paracetamol, parecoxib and magnesium sulphate as routine. Clonidine and phrenic nerve blocks were also used in selected patients. All patients received postoperative patient controlled analgesia with morphine. Continuous data is presented as mean ± standard deviation; non-parametric data is expressed as median (interquartile range). Results During the pilot, 37 patients were included in the study: 23 male and 14 female. The mean age was 67.7 ± 10.3 years. The mean BMI was 28.3 ± 5.7 kg/m2with median ASA status 3 (range 2 - 4). The mean percentage predicted FEV1was 88.0 ± 23.1%. The mean 6-minute walk test distance was 367 ± 108m. The surgeries included 32 lobectomies and 5 anatomical segmentectomies; 31 procedures were performed thoracoscopically (28 uniportal, 2 subxiphoid and 1 multiportal) and 6 were performed by thoracotomy. The mean duration of surgery was 189 ± 58 minutes. The mean length of stay in the postanaesthetic recovery area was 114 ± 37 minutes. The mean opioid consumption of the patients within the first 24 hours was 15.5 ± 20.7mg. The median hospital length of stay was 3 days (IQR 2-4). Conclusion We have demonstrated that OFA is feasible and safe in patients undergoing thoracic surgery and it should be considered as part of the enhanced recovery programmes, to minimise the complications associated with the perioperative use of opioids.
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