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Anesthesia Journals | Clinical Anesthesia Journals | Pain Medicine Journals | Journal of Clinical Anesthesia and Pain Medicine | Scient Open Access
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Journal of Clinical Anesthesia and Pain Medicine

Aabstract


Research Article

A Randomized Controlled, Double-Blind Trial Evaluating the Effect of Opioid-Free Versus Opioid General Anaesthesia on Postoperative Pain and Discomfort Measured by the QoR-40

Jan P Mulier, Ruben Wouters, Bruno Dillemans, Marc Dekock

Correspondence Address :

Jan P. Mulier
Department of Anaesthesiology
AZ Sint Jan Brugge-Oostende
Ruddershove 10, 8000 Bruges, Belgium
Email: jan.mulier@azsintjan.be

Received on: January 31, 2018, Accepted on: February 07, 2018, Published on: February 15, 2018

Citation: Jan P. Mulier, Ruben Wouters, Bruno Dillemans, Marc De Kock (2018). A randomized controlled, double-blind trial evaluating the effect of opioid-free versus opioid general anaesthesia on postoperative pain and discomfort measured by the QoR-40

Copyright: 2018 Jan P. Mulier, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract
This study measured post-operative opioid consumption and quality of recovery after Opioid-Free Anaesthesia (OFA). 50 Patients undergoing elective laparoscopic bariatric surgery were randomised in two groups. Before induction, the Opioid Anaesthesia (OA) group received 0.5 mcg/kg sufentanil, while the OFA group received 0.5 mcg/kg dexmedetomidine, 0.25 mg/kg ketamine, and 1.5 mg/kg lidocaine. Anaesthesia was induced with propofol and rocuronium and the bispectral index was maintained in both groups between 40% and 60% by adapting end-tidal sevoflurane. Anaesthesia was further maintained with sufentanil or lidocaine and dexmedetomidine. Postoperative analgesia was achieved with 4 g/day paracetamol and with patient-controlled 2-mg morphine. Kalkman and APAIS were measured before anaesthesia. QoR-40, VAS, morphine consumption and cortisol levels were measured postoperatively.
The post-operative opioid consumption was lower in the PACU and quality of recovery was higher next day after OFA versus OA. There were no differences between the two groups regarding age, weight, height, body mass index, gender, information desire, and incidence of obstructive sleep apnoea syndrome, combined anxiety score, and Kalkman points. No differences were found in the number of patients having had one or more intra operative hemodynamic problems. Post-operative major adverse events, like hypertension and bleeding, were significant higher in the OA group.
Postoperative saturation in the post-anaesthesia care unit while giving a 6 l/min O2 mask was lower in the OA group with a higher incidence of hypertension, postoperative nausea and vomiting, shivering or feeling cold and a higher VAS score. The following morning patients in the OFA group had higher QoR-40 scores and lower VAS scores cortisol levels.

Keywords: Opioid free general anaesthesia, Laparoscopic bariatric surgery, Randomized controlled clinical trial, Quality of recovery (QoR-40), Enhanced recovery after surgery (ERAS), Post-operative pain and discomfort