Effect of Opioid Free Anesthesia versus Opioid-Balanced Anesthesia on Systemic Inflammatory Responses for Elective Oncologic Abdominal Surgeries in Suez Canal University Hospitals: A Comparative Randomized Clinical Trial
Main Article Content
Keywords
Elective Oncologic Abdominal Surgeries; Opioids; Inflammatory Responses
Abstract
Opioids administration consequences are neither scarce nor benign for the patient. The aim of the present study was to improve the systemic inflammatory stress responses and functional outcomes in the patients undergoing elective oncologic abdominal surgery. Patients and methods: This prospective clinical trial included 60 patients undergoing elective oncologic abdominal surgery. Patients were equal divided to Opioid Based Anesthesia (OBA) group, and Opioid Free Anesthesia (OFA) group. Each participant was subjected to medical history, physical examination, anesthetic assessments, and laboratory investigations. Results: Both groups were well matched as regard sex and age with no statistically significant difference between them. However, the weight of the OFA patients was significantly higher than that of the OBA group. HR and MBP were significantly lower in the OFA group than OBA group at 90 and 120 minutes after induction, at the end of surgery, at extubation, as well as one hour and two hours after surgery. CRP level was significantly lower in the OFA group than in the OBA group at 2 and 24 hours after surgery periods. TLC levels were significantly lower in the OFA group than in the OBA group at 24 hours after surgery. Conclusion: OFA is beneficial and effective than OBA. OFA could be recommended in the patients undergoing elective oncologic abdominal surgeries.
References
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32- Rogers TJ, Peterson PK. Opioid G protein-coupled receptors: signals at the crossroads of inflammation. Trends Immunol 2003; 24(3):116-21.
33- Ghazavi A, Solhi H, Moazzeni SM, Rafiei M, Mosayebi G. Cytokine profiles in long-term smokers of opium (Taryak). J Addict Med 2013; 7(3):200-3.
34- Nabati S, Asadikaram G, Arababadi MK, Shahabinejad G, Rezaeian M, Mahmoodi M, et al. The plasma levels of the cytokines in opium-addicts and the effects of opium on the cytokines secretion by their lymphocytes. Immunol Lett 2013; 152(1):42-6.
35- Chopan M, Littenberg B. C-reactive protein and prescription opioid use. J Nat Sci 2015; 1(6):122.
36- Cabellos Olivares M, Labalde Martínez M, Torralba M, Rodríguez Fraile JR, Atance Martínez JC. C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study. J Surg Oncol 2018; 117(4):717-24.
2- Egan TD. Are opioids indispensable for general anaesthesia? Br J Anaesth 2019; 122(6):e127-e35.
3- Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol 2019; 33(3):353-60.
4- Lavand'homme P, Estebe JP. Opioid-free anesthesia: a different regard to anesthesia practice. Curr Opin Anaesthesiol 2018; 31(5):556-61.
5- Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks. Best Pract Res Clin Anaesthesiol 2017; 31(4):533-45.
6- Sultana A, Torres D, Schumann R. Special indications for Opioid Free Anaesthesia and Analgesia, patient and procedure related: Including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery. Best Pract Res Clin Anaesthesiol 2017; 31(4):547-60.
7- Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth 2016; 116(6):811-21.
8- Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol 2015; 65(3):191-9.
9- Card E, Pandharipande P, Tomes C, Lee C, Wood J, Nelson D, et al. Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit. Br J Anaesth 2015; 115(3):411-7.
10- Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 2015; 157(2):362-80.
11- Kvarnström AL, Sarbinowski RT, Bengtson JP, Jacobsson LM, Bengtsson AL. Complement activation and interleukin response in major abdominal surgery. Scand J Immunol 2012; 75(5):510-6.
12- Iwasaki M, Edmondson M, Sakamoto A, Ma D. Anesthesia, surgical stress, and "long-term" outcomes. Acta Anaesthesiol Taiwan 2015; 53(3):99-104.
13- Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology 2017; 126(4):729-37.
14- Wall T, Sherwin A, Ma D, Buggy DJ. Influence of perioperative anaesthetic and analgesic interventions on oncological outcomes: a narrative review. Br J Anaesth 2019; 123(2):135-50.
15- Rittner HL, Brack A, Stein C. Pain and the immune system. Br J Anaesth 2008; 101(1):40-4.
16- Rittner HL, Brack A, Stein C. [Pain and the immune system: friend or foe?]. Anaesthesist 2002; 51(5):351-8.
17- Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 2012; 116(6):1312-22.
18- Shehabi Y, Howe BD, Bellomo R, Arabi YM, Bailey M, Bass FE, et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med 2019; 380(26):2506-17.
19- Demiri M, Antunes T, Fletcher D, Martinez V. Perioperative adverse events attributed to α2-adrenoceptor agonists in patients not at risk of cardiovascular events: systematic review and meta-analysis. Br J Anaesth 2019; 123(6):795-807.
20- Beloeil H, Garot M, Lebuffe G, Gerbaud A, Bila J, Cuvillon P, et al. Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery. Anesthesiology 2021; 134(4):541-51.
21- Edokpolo LU, Mastriano DJ, Serafin J, Weedon JC, Siddiqui MT, Dimaculangan DP. Discharge Readiness after Propofol with or without Dexmedetomidine for Colonoscopy: A Randomized Controlled Trial. Anesthesiology 2019; 131(2):279-86.
22- Shoshiashvili V, El-Molla A, Fetouh F, Alotaibi R, Kandil A, Shaalan O, et al. A prospective study about safety and efficacy of perioperative lidocaine infusion. Surgery 2022; 19(1):10.
23- Soudi AM, Hammad RA, ElShafie MA, Ahmed IMAS, Alhadidy MA. Comparing opioid free general anesthesia to traditional balanced general anesthesia regarding achievement of enhanced recovery in laparoscopic bariatric surgeries. Ain-Shams J Anesthesiol 2022; 14(1):24.
24- Ibrahim ZA, Eldosoky GA, abosonna ka. Opioid free multimodal analgesia versus opioid based analgesia in bariatric surgery outcome. Al-Azhar Int Med J 2021; 2(10):43-8.
25- Choi JW, Joo J-D, Kim D-W, In J-H, Kwon S-Y, Seo K, et al. Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control. J Korean Med Sci 2016; 31(9):1485-90.
26- Guinot PG, Spitz A, Berthoud V, Ellouze O, Missaoui A, Constandache T, et al. Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: a retrospective matched case-control study. BMC Anesthesiol 2019; 19(1):136.
27- Lavand'homme P. Opioid-free anaesthesia: Pro: damned if you don't use opioids during surgery. Eur J Anaesthesiol 2019; 36(4):247-9.
28- Reece AS. High-sensitivity CRP in opiate addiction: relative and age-dependent elevations. Cardiovasc Toxicol 2012; 12(2):149-57.
29- Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet 2011; 377(9784):2215-25.
30- Stein C. Targeting pain and inflammation by peripherally acting opioids. Front Pharmacol 2013; 4:123.
31- Stein C, Lang LJ. Peripheral mechanisms of opioid analgesia. Curr Opin Pharmacol 2009; 9(1):3-8.
32- Rogers TJ, Peterson PK. Opioid G protein-coupled receptors: signals at the crossroads of inflammation. Trends Immunol 2003; 24(3):116-21.
33- Ghazavi A, Solhi H, Moazzeni SM, Rafiei M, Mosayebi G. Cytokine profiles in long-term smokers of opium (Taryak). J Addict Med 2013; 7(3):200-3.
34- Nabati S, Asadikaram G, Arababadi MK, Shahabinejad G, Rezaeian M, Mahmoodi M, et al. The plasma levels of the cytokines in opium-addicts and the effects of opium on the cytokines secretion by their lymphocytes. Immunol Lett 2013; 152(1):42-6.
35- Chopan M, Littenberg B. C-reactive protein and prescription opioid use. J Nat Sci 2015; 1(6):122.
36- Cabellos Olivares M, Labalde Martínez M, Torralba M, Rodríguez Fraile JR, Atance Martínez JC. C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study. J Surg Oncol 2018; 117(4):717-24.
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Published
Dec 26, 2022
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Amr Mohamed Sabry, Alaa El-Din Mohamed El-kassaby, Salah Abd-ElFattah M. Ismail, Emad El-dien Ahmed, Ahmed Ahmed El-lilly. (2022). Effect of Opioid Free Anesthesia versus Opioid-Balanced Anesthesia on Systemic Inflammatory Responses for Elective Oncologic Abdominal Surgeries in Suez Canal University Hospitals: A Comparative Randomized Clinical Trial. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 447–459. https://doi.org/10.53555/jptcp.v29i04.3973
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