Lessons from the Analysis of a Retrospective Cohort of Patients Who Underwent Large Open Abdominal Surgery Under Total I
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ORIGINAL RESEARCH ARTICLE
Lessons from the Analysis of a Retrospective Cohort of Patients Who Underwent Large Open Abdominal Surgery Under Total Intravenous Opioid‑Free Anesthesia Jean‑Pierre Estebe1 · Mathieu Morel1 · Timothée Daouphars1 · Elric Ardant1 · Chloé Rousseau2 · Anaïs Drouet1 · Camille Bosquet1 · Karim Boudjema3 Accepted: 30 October 2020 © The Author(s) 2020
Abstract Background Opioid-free anesthesia (OFA) is a new method of anesthesia based on a paradigm shift. Under general anesthesia, the physiology and/or the pathophysiological variations clinically observed are more a reflection of a systemic reaction to the stress (surgical and anesthesia stresses) than a true reflection of pain. Objective To report the results of a large monocenter, retrospective, non-interventional observational study of all consecutive patients who received a total intravenous (IV)-OFA protocol for the surgical management of major open abdominal and urological surgery. Patients and Methods We retrospectively extracted the anesthesia files of 311 consecutive patients (regional anesthesia excluded). No opioids were administered to any of these patients during the surgery. IV morphine administered in the recovery room was the primary endpoint of the study. The secondary endpoints included the amount of opioid required during the first two postoperative days, as well as the maximum pain intensity. Results Only very small doses of IV morphine were administered. The mean total morphine titration was 2 mg (1.9 ± 2.9 mg), corresponding to control of the maximal level of pain to 2.1 ± 2.6 as evaluated with a numerical scale in the postoperative care unit. Similarly, we observed a very low level of morphine consumption during the first two postoperative days. Conclusions These results highlight the safety and the feasibility of our total IV-OFA protocol, thus confirming this new paradigm. Under general anesthesia, the cardiovascular and inflammatory response to the stress could be reliably managed through a multimodal approach without a need for opioids. In the postoperative period, very low doses of opioids were required.
Key Points Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40801-020-00218-3) contains supplementary material, which is available to authorized users. * Jean‑Pierre Estebe jean‑pierre.estebe@chu‑rennes.fr 1
Department of Anesthesiology, Intensive Care, and Pain Medicine, University Hospital of Rennes, Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
2
Clinical Investigation Center (CIC‑INSERM 1414), University Hospital of Rennes, Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
3
Department of Abdominal Surgery, University Hospital of Rennes, Rue Henri Le Guilloux, 35033 Rennes Cedex 9, France
Anesthesia without opioids during large open abdominal surgery does not increase the pain and/or the postoperative opioid requirement. The benefits of opioid-free anesthesia include faster rehabilitation. Pain is probably best prevented by a multim
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