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Minerva Anestesiologica 2020 Aug 04

DOI: 10.23736/S0375-9393.20.14515-2


lingua: Inglese

Opioid free anesthesia: evidence for short and long-term outcome

Dario BUGADA 1 , Luca F. LORINI 1, Patricia LAVAND'HOMME 2

1 Emergency and Intensive Care Department, ASST Papa Giovanni XXIII°, Bergamo, Italy; 2 Cliniques Universitaires Saint-Luc, University Catholic of Louvain, Brussels, Belgium


The introduction of synthetic opioids in clinical practice played a major role in the history of anesthesiology. For years, anesthesiologists have been thinking that opioids are needed for intraoperative anesthesia. However, we now know that opioids (especially synthetic short-acting molecules) are definitely not ideal analgesics and may even be counterproductive, increasing postoperative pain. As well, opioids have revealed important drawbacks associated to poor perioperative outcomes. As a matter of fact, efforts in postoperative pain management in the last 30 years were driven by the idea of reducing/eliminating opioids from the postoperative period. However, a modern concept of anesthesia should eliminate opioids already intra-operatively towards a balanced, opioid-free approach (opioid-free anesthesia - OFA). In OFA drugs and techniques historically proven for their efficacy are combined in rational and defined protocols. They include ketamine, alpha-2 agonists, lidocaine, magnesium, anti-inflammatory drugs and regional anesthesia. Promising results have been obtained on perioperative outcome. For sure, analgesia is not reduced with OFA, but it is effective and with less opioid-related side effects. These benefits may be of particular importance in some high-risk patients, like OSAS, obese and chronic opioid-users/abusers. OFA may also increase patient-reported outcomes; despite it is difficult to specifically rule out the effect of intraoperative opioids. Finally, few data are available on long-term outcomes (persistent pain and opioid abuse, cancer outcome). New studies and data are required to elaborate the optimal approach for each patient/surgery, but interest and publication are increasing and may open the road to the wider adoption of OFA.

KEY WORDS: Opioid free anesthesia; Adjuvants; Outcome; Analgesia; Opioids

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