Low opioid anesthesia and opioid free anesthesia use in pain control treatment in postoperative period

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Ewa Komorowska-Wojtunik ◽  
Anna M. Lotowska-Cwiklewska ◽  
Urszula Kosciuczuk ◽  
Andrzej Siemiatkowski
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Pain Control ◽  
Scientific Evidence ◽  
Opioid Analgesics ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Control Treatment ◽  
Anesthetic Techniques ◽  
Post Operative Nausea

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.

scholarly journals Multimodal anesthesia and analgesia at the stages of the perioperative period in children with abdominal surgical pathology

2021 ◽  
Vol 24 (1) ◽  
pp. 27-31
Author(s):  
Elmira A. Satvaldieva ◽  
Otabek Ya. Fayziev ◽  
Anvar S. Yusupov
Keyword(s):  
General Anesthesia ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Postoperative Recovery ◽  
Surgical Pathology ◽  
Abdominal Organ ◽  
Epidural Blockade ◽  
Abdominal Operations

Aim of the study was assess both the effectiveness and safety of anesthetic management and optimizing postoperative anesthesia under conditions of multimodal anesthesia and analgesia during abdominal operations in children. Patients and methods. The authors examined 58 children aged 1 to 17 years with abdominal operations (malformations, diseases, and abdominal organ injuries). To ensure anesthetic protection, patients underwent combined general anesthesia with propofol and fentanil (induction) with inhalation of sevoflurane + propofol intra venous (maintenance) in combination with epidural blockade with bupivacaine. Results. According to surgical intervention, the arrangement of perioperative analgesic protection provided a favorable correction of the hemodynamic status of patients, a decrease in inhalation anesthetic, promoted a smooth course of the postoperative period, a long painless period, an excellent psychoemotional background, and rapid postoperative recovery.

scholarly journals Blood transfusion in cardiac surgery: Does the choice of anesthesia or type of surgery matter?

2013 ◽  
Vol 70 (5) ◽  
pp. 439-444 ◽  
Author(s):  
Vojislava Neskovic ◽  
Predrag Milojevic ◽  
Dragana Unic-Stojanovic ◽  
Zoran Slavkovic
Keyword(s):  
Blood Transfusion ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Postoperative Bleeding ◽  
Perioperative Period ◽  
Clinical Decision ◽  
Anesthetic Techniques ◽  
Blood Products ◽  
Off Pump ◽  
Thoracic Epidural

Background/Aim. In spite of the evidence suggesting a significant morbidity associated with blood transfusions, the use of blood and blood products remain high in cardiac surgery. To successfully minimize the need for blood transfusion, a systematic approach is needed. The aim of this study was to investigate the influence of different anesthetic techniques, general vs combine epidural and general anesthesia, as well as different surgery strategies, on-pump vs off-pump, on postoperative bleeding complications and the need for blood transfusions during perioperative period. Methods. Eighty-two consecutive patients scheduled for coronary artery bypass surgery were randomized according to surgical and anesthetic techniques into 4 different groups: group 1 (patients operated on off-pump, under general anesthesia); group 2 (patients operated on off-pump, with combined general and high thoracic epidural anesthesia); group 3 (patients operated on using standard revascularization technique, with the use of extracorporeal circulation, under general anesthesia), and group 4 (patients operated on using standard revascularization technique, with the use of extracorporeal circulation, with combined general and high thoracic epidural anesthesia). Indications for transfusion were based on clinical judgment, but a restrictive policy was encouraged. Bleeding was considered significant if it required transfusion of blood or blood products, or reopening of the chest. The quantity of transfused blood or blood products was specifically noted. Results. None of the patients was transfused blood or blood products during the surgery, and as many as 70/81 (86.4%) patients were not transfused at all during hospital stay. No difference in postoperative bleeding or blood transfusion was noted in relation to the type of surgery and anesthetic technique applied. If red blood cells were transfused, postoperative bleeding was the most influential parameter for making clinical decision. Conclusion. No influence of off-pump surgery or epidural anesthesia on blood transfusion requirements during a perioperative period was confirmed by this study. It seems, however, that encouraging lower hemoglobin triggers in clinical decision-making could result in less transfusions during surgery or hospital stay.

scholarly journals The Role of Interfascial Plane Blocks in Paediatric Regional Anaesthesia: A Narrative Review of Current Perspectives and Updates

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Sujana Dontukurthy ◽  
Roshanak Mofidi
Keyword(s):  
Pain Control ◽  
Regional Anaesthesia ◽  
Early Mobilization ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Narrative Review ◽  
Complication Rates ◽  
Early Recovery ◽  
Nerve Blocks ◽  
Anaesthesia Practice

Regional anaesthesia has been increasingly used for analgesia in the perioperative period in paediatric anaesthesia for better pain control and improved patient outcomes. Interfascial plane blocks are considered as a subgroup of peripheral nerve blocks. The advent of ultrasound in modern regional anaesthesia practice has led to the evolution of various interfascial plane blocks. The ease of their performance and the low complication rates, compared with neuraxial anaesthesia, have led to their increased use in the perioperative period. Interfascial plane blocks are often incorporated in the multimodal analgesia regimen in the early recovery and ambulation after surgery protocols for various chest wall and abdominal surgeries. This achieves better pain control and decreases the requirements of opioids in the perioperative period, thereby facilitating early mobilization and discharge. This narrative review focuses on the relevant anatomic considerations, technique for the performance of each block along with its current applications and limitations, and includes a review of the current literature on various interfascial plane blocks in paediatric regional anaesthesia.

Postoperative Pain Management Surgery

2018 ◽  
Author(s):  
Abhishek Parmar
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Perioperative Period ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Anesthetic Techniques ◽  
Clinical Approach ◽  
Acute Setting ◽  
Pain Medications

Optimal pain management in the perioperative period is essential to improving patient quality of life, preventing postoperative complications, and ensuring improved surgical outcomes.1 This review discusses the optimal clinical approach to pain management in the acute setting, centering on the concept of multimodal analgesia. Various opioid and nonopioid medications available for treating acute pain are discussed, with a focus on the “pain ladder,” adverse effects of pain medications, epidural and regional anesthetic techniques, and common pitfalls to avoid when managing postoperative pain. This review does not discuss chronic pain management.

scholarly journals Use of systemic lidocaine for postoperative acute pain management in single-lung transplantation: Case report

2020 ◽  
Vol 68 (2) ◽  
Author(s):  
Jairo Moyano ◽  
Paula Rodríguez ◽  
Cindy Lorena Fierro
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Lung Transplantation ◽  
Acute Pain ◽  
Postoperative Period ◽  
Opioid Analgesics ◽  
Postoperative Pain Management ◽  
Multimodal Analgesia ◽  
Single Lung Transplantation ◽  
Function Recovery

Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.

scholarly journals PREEMPTIVE ANALGESIA IN ANORECTAL SURGERY: STUDY PROTOCOL FOR A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND TRIAL

2021 ◽  
pp. 5-12
Author(s):  
T. N. Garmanova ◽  
D. R. Markaryan ◽  
E. A. Kazachenko ◽  
A. M. Lukianov ◽  
M. A. Agapov
Keyword(s):  
Postoperative Pain ◽  
Spinal Anesthesia ◽  
Pain Control ◽  
Opioid Analgesics ◽  
Life Time ◽  
Multimodal Analgesia ◽  
Preemptive Analgesia ◽  
Anorectal Surgery ◽  
Double Blind ◽  
Opioid Administration

Aim: To assess the efficiency of preemptive analgesia with Ketoprofen 10 mg 2 hours before procedure per os with spinal anesthesia to decrease postoperative pain and the amount of used analgesics.Methods: Patients of our clinic who meet the following inclusion criteria are included: they must be diagnosed with anorectal disease and planned anorectal procedure. After signing the consent all participants are randomly divided into 2 groups: the first one gets a tablet with 10 mg Ketoprofen, the second one gets a tablet containing starch per os 2 hours before surgery (72 participants per arm). Patients of both arms receive spinal anesthesia and undergo open hemorrhoidectomy. Following the procedure the primary and secondary outcomes are evaluated: opioid administration intake, the pain at rest and during defecation, duration and frequency of other analgesics intake, readmission rate, overall quality of life, time from the procedure to returning to work and the complications rate.Discussion: Multimodality pain management has been shown to improve pain control and decrease opioid intake in patients after anorectal surgery in several studies. Gabapentin can be considered as an alternative approach to pain control as NSAIDs have limitative adverse effects. Systemic admission of ketorolac with local anesthetics also showed significant efficacy in patients undergoing anorectal surgery. We hope to prove the efficacy of multimodal analgesia including preemptive one for patients undergoing anorectal procedure that will help to hold postoperative pain level no more than 3-4 points on VAS with minimal consumption of opioid analgesics.

scholarly journals The comparison of effectiveness of two variants of preventive anesthesia/analgesia in cancer surgery

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 44-50
Author(s):  
I I Lisnyy
Keyword(s):  
Plasma Level ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Multimodal Analgesia ◽  
Surgical Interventions ◽  
Perioperative Analgesia ◽  
Contentious Issue ◽  
Comparison Of Effectiveness

Despite modern drugs and technologies in medicine, the questions of adequate analgesia in the postoperative period remain quite relevant. The effectiveness of preventive analgesia in the perioperative period remains a contentious issue. The study included 53 oncosurgical patients. Gr.1 received dexketoprofen in combination with paracetamol for perioperative analgesia before the operation, Gr.2 the same medication was given before closing the operating wound. Anesthesia in both groups included an inhaled (Sevoran) and an extended epidural. The study showed that the pain intensity on ANI monitoring and the total dose of fentanyl was less in Gr.1, compared to Gr.2. Cortisol plasma level and the level of glycemia in the perioperative period were less in patients in Gr.1 than in Gr.2. Pain intensity after surgery during first postoperative day was lower in Gr.1, then in Gr.2. The administration of multimodal analgesia with paracetamol and dexketoprofen prior to the surgical interventions provides for the best quality of perioperative analgesia in oncological surgical interventions.

scholarly journals Infiltrative analgesia of the skin flap in children with craniosynostosis after reconstructive surgery on skull bones

2020 ◽  
Vol 16 (6) ◽  
pp. 37-45
Author(s):  
O. N. Pulkina ◽  
V. P. Ivanov ◽  
V. I. Gurskaya ◽  
E. V. Parshin
Keyword(s):  
Reconstructive Surgery ◽  
Postoperative Period ◽  
Skin Flap ◽  
Opioid Analgesics ◽  
Multimodal Analgesia ◽  
Non Invasive ◽  
Invasive Hemodynamic Monitoring ◽  
Group 2 ◽  
Group 1 ◽  
Skull Bones

The objective of the study is to evaluate the effectiveness of analgesia by infiltration of the skin flap with local anesthetic in children with craniosynostosis after reconstructive surgery.Materials and subjects. 50 children with craniosynostosis, who underwent reconstructive surgery on skull bones, were divided into two groups based on the method of postoperative anesthesia: in Group 1(experimental), the infiltration of the skin flap was used within multimodal anesthesia, while in Group 2, it was standard parenteral use of analgesic drugs. In the postoperative period, pain severity was assessed by FLACC scales, the amount of opioid and non-opioid analgesics consumed was assessed by the formalized Analgesiс Assessment Scale (FSA), and non-invasive hemodynamic monitoring (BP, HR) was performed.Results. The statistical analysis of the results revealed significant differences between groups in the assessment results of FSA and FLACC scales. In Group 1, the level of postoperative pain was significantly lower compared to Group 2. The amount of opioid and non-opioid analgesics consumed was also significantly lower in Group 1.Conclusion. The use of the infiltration of the skin flap as part of multimodal analgesia in children with craniosynostosis, after reconstructive surgery on skull bones significantly reduces the intensity of pain and the amount of opioid analgesics consumed in the postoperative period.

scholarly journals Pain management in obstetrics and gynecology

Pain medicine ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 69-73
Author(s):  
Ye V Grigimalsky ◽  
A Y Garga
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Control ◽  
Surgical Intervention ◽  
Opioid Analgesics ◽  
Multimodal Analgesia ◽  
Obstetrics And Gynecology ◽  
Negative Consequences ◽  
Acute Postoperative Pain ◽  
Regional Analgesia

The problem of acute postoperative pain is present throughout the lifetime of surgery and, unfortunately, does not lose its relevance today. Inadequate pain control in the postoperative period leads to negative consequences. Multimodal analgesia is currently the method of choice for postoperative anesthesia. The basis is the prescription of paracetamol (Infulgan®) in combination or without NSAIDs with the addition of methods of regional analgesia and, in case of insufficient effect, the use of opioid analgesics lies in the basisi of this method. Choosing one or another scheme of multimodal analgesia is determined, above all, is due to the invasiveness of the surgical intervention performed.

scholarly journals DEXMEDETOMIDINE AS A COMPONENT OF ANESTHESIAAND PROMISING BASE FOR OPIOID FREE ANALGESIA

2018 ◽  
Vol 12 (2) ◽  
pp. 82-90
Author(s):  
Alexei M. Ovechkin ◽  
M. E Politov ◽  
E. L Bulanova
Keyword(s):  
General Anesthesia ◽  
Pain Intensity ◽  
Postoperative Period ◽  
Intravenous Infusion ◽  
Opioid Analgesics ◽  
Early Postoperative Period ◽  
Inhalation Anesthetics ◽  
Intravenous Anesthetics ◽  
Average Pain Intensity ◽  
Average Pain

Data suggests that intravenous infusion of dexmedetomidine, started 15-20 minutes before the induction of general anesthesia, can significantly reduce the doses of intravenous anesthetics, MAC of inhalation anesthetics, and requirements in opioid analgesics during the surgery. Intraoperative infusion of dexmedetomidine prolongs the time of the first requirement of analgesics after surgery, reduces the average pain intensity in the early postoperative period, and also requirements in opioid analgesics.

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