Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

被引:7
作者
Vishnuraj, K. R. [1 ]
Singh, Kunal [1 ]
Sahay, Nishant [1 ]
Sinha, Chandni [1 ]
Kumar, Amarjeet [1 ]
Kumar, Neeraj [1 ]
机构
[1] All India Inst Med Sci Patna, Dept Anaesthesiol, Room 501,B5A, Patna 801507, India
来源
ANESTHESIA AND PAIN MEDICINE | 2024年 / 19卷 / 02期
关键词
Anesthesia; Dexmedetomidine; KetamineX; Laparoscopic cholecystectomy; Opioid analgesics; Postoperative pain; POSTOPERATIVE ANALGESIA; SURGERY; PAIN; CONSUMPTION; LIDOCAINE; RECOVERY; EFFICACY;
D O I
10.17085/apm.23097
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and anal-gesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective lapa-roscopic cholecystectomy under opioid-free and opioid-based anesthesia. Methods: Study included 88 patients aged 18-60 years with American Society of Anesthe-siologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentan-yl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nau-sea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Results: Both groups had similar demographic characteristics. The opioid-free group re-quired lesser analgesia within the first 2 h (61.4 +/- 17.4 vs. 79.0 +/- 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 +/- 28.2 vs. 164 +/- 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Conclusions: Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associ-ated with decreased PONV.
引用
收藏
页码:109 / 116
页数:124
相关论文
共 17 条
[1]   Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study [J].
Bakan, Mefkur ;
Umutoglu, Tarik ;
Topuz, Ufuk ;
Uysal, Harun ;
Bayram, Mehmet ;
Kadioglu, Huseyin ;
Salihoglu, Ziya .
REVISTA BRASILEIRA DE ANESTESIOLOGIA, 2015, 65 (03) :191-199
[2]   Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients [J].
Bhardwaj, Shaman ;
Garg, Kamakshi ;
Devgan, Sumeet .
JOURNAL OF ANAESTHESIOLOGY CLINICAL PHARMACOLOGY, 2019, 35 (04) :481-486
[3]   Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity Systematic Review and Meta-analysis of Randomized Controlled Trials [J].
Blaudszun, Gregoire ;
Lysakowski, Christopher ;
Elia, Nadia ;
Tramer, Martin R. .
ANESTHESIOLOGY, 2012, 116 (06) :1312-1322
[4]   Perioperative intravenous ketamine for acute postoperative pain in adults [J].
Brinck, Elina C. V. ;
Tiippana, Elina ;
Heesen, Michael ;
Bell, Rae Frances ;
Straube, Sebastian ;
Moore, R. Andrew ;
Kontinen, Vesa .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2018, (12)
[5]   Misuse of Medicines in the European Union: A Systematic Review of the Literature [J].
Casati, Alicia ;
Sedefov, Roumen ;
Pfeiffer-Gerschel, Tim .
EUROPEAN ADDICTION RESEARCH, 2012, 18 (05) :228-245
[6]   Intraloperative esmolol infusion in the absence of Opioids spares postoperative fentanyl in patients undergoing ambulatory Laparoscopic cholecystectomy [J].
Collard, Vincent ;
Mistraletti, Giovanni ;
Taqi, Ali ;
Asenjo, Juan Francisco ;
Feldman, Liane S. ;
Fried, Gerald M. ;
Carli, Franco .
ANESTHESIA AND ANALGESIA, 2007, 105 (05) :1255-1262
[7]   Side Effect Rates of Opioids in Equianalgesic Doses via Intravenous Patient-Controlled Analgesia: A Systematic Review and Network Meta-analysis [J].
Dinges, Hanns-Christian ;
Otto, Stephan ;
Stay, David K. ;
Baeumlein, Synke ;
Waldmann, Susanne ;
Kranke, Peter ;
Wulf, Hinnerk F. ;
Eberhart, Leopold H. .
ANESTHESIA AND ANALGESIA, 2019, 129 (04) :1153-1162
[8]   Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis [J].
Fletcher, D. ;
Martinez, V. .
BRITISH JOURNAL OF ANAESTHESIA, 2014, 112 (06) :991-1004
[9]   Scientists, Officials Eye Tools Aimed at Combating Abuse of Painkillers [J].
Kuehn, Bridget M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2012, 307 (01) :19-21
[10]   Intraoperative Ketamine Reduces Perioperative Opiate Consumption in Opiate-dependent Patients with Chronic Back Pain Undergoing Back Surgery [J].
Loftus, Randy W. ;
Yeager, Mark P. ;
Clark, Jeffrey A. ;
Brown, Jeremiah R. ;
Abdu, William A. ;
Sengupta, Dilip K. ;
Beach, Michael L. .
ANESTHESIOLOGY, 2010, 113 (03) :639-646