The principles of opioid‑free anesthesia and postoperative analgesia, our experience in bariatric surgery

Česká verzia

Authors: P. Píza; E. Uchytilová; A. Čermáková; E. Kieslichová
Authors place of work: The principles of opioid‑‑free anesthesia and postoperative analgesia, our experience in bariatric surgery
Published in the journal: Anest. intenziv. Med., 33, 2022, č. 1, s. 25-31
Category: Review Article

Summary

Opioid-free anaesthesia and postoperative analgesia are methods of perioperative care without the use of opioids, whereas the principles of opioid-sparing anaesthesia and postoperative analgesia lie in the use of opioids in minimal doses. These methods are based on multimodal approach and reduce the influence of opioid side-effects on postoperative course. Within general opiod-free anaesthesia and systemic postoperative analgesia a combination of adjuvant, non-opioid analgetics and non-steroidal antiinflammatory drugs is used, which enables to reduce opioid consumption and the incidence of opioid side effects. NMDA receptor antagonists, local anaesthetics and α2-receptor agonists are the most frequenly used drugs. Benefit of opioid-free anaethesia and analgesia was primarily shown in patients, for whom opioid side-effects mean significant risk of postoperative complications, for example morbidly obese patients undergoing bariatric surgical procedures. In our institute opioid-free approach proved to be effective and beneficial in patients undergoing laparoscopic assisted sleeve gastrectomies. Even though it is not possible to recommend opioid-free anaesthesia and analgesia as a method of choice in general, opioid-sparing approach is a fixed part of guidelines for anaesthesia and postoperative analgesia in risk patients, who are seriously endangered by opioid side-effects.

Keywords:

opioids – opioid‑ free anaesthesia – opioid‑sparing anaesthesia – mulimodal systemic analgesia

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