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Opioid-free anaesthesia may enhance postoperative recovery by reducing opioid-related side effects such as nausea, hyperalgesia or tolerance. The objective was to investigate the impact of multimodal opioid-free general anaesthesia on postoperative nausea, vomiting, pain and morphine consumption compared to the traditional opioid-based approach. This study was conducted as a prospective parallel-group randomised controlled trial. Perioperative Care. 152 adult women undergoing elective inpatient gynaecological laparoscopy. Patients were randomly assigned for opioid-free anaesthesia (Group OF) with dexmedetomidine, esketamine and sevoflurane or to have opioid-based anaesthesia (Group C) with sufentanil and sevoflurane. Primary outcome was the occurrence of nausea within 24 h after surgery. Patients were assessed for the incidence and severity of PONV, postoperative pain and morphine consumption and recovery characteristics. Patients in both groups had comparable clinical and surgical data. 69.7% of patients in the control group and 68.4% of patients in the opioid-free group met the primary endpoint (OR 1.06, 95% Confidence Interval (CI) (0.53; 2.12) p = 0.86). The incidence of clinically important PONV defined by the PONV impact scale was 8.1% (Group C) vs 10.5% (OF); p = 0.57). Antiemetic requirements, pain scores and morphine consumption were equivalent in both groups. Postoperative sedation was significantly increased in group OF (p < 0.001), and the median length of stay at the post-anaesthesia care unit was 69.0 min (46.5–113.0) vs 50.0 (35.3–77.0) minutes in the control group (p < 0.001). Opioid-free multimodal general anaesthesia is feasible but did not decrease the incidence of PONV, or reduce pain scores and morphine consumption compared to an opioid-containing anaesthetic regimen. •This trial assessed opioid-free anaesthesia in comparison to opioid-based anaesthesia for gynaecological laparoscopy.•Both study groups did not differ with respect to postoperative nausea and vomiting, pain or morphine consumption.•Multimodal general anaesthesia was associated with an increased time to discharge from the post-anaesthesia care unit.

Background: Opioids remain the most effective component of systemic analgesia and are considered safe and beneficial when administered at the lowest effective dose. Nevertheless, their potential adverse effects may diminish the quality of the postoperative period or, in some cases, lead to life-threatening complications. This analysis examines whether the mandatory implementation of a standardised protocol offers opioid-sparing potential. Methods: In this single-centre retrospective cohort study, intraoperative opioid consumption during laparoscopic appendectomy was compared between patients anaesthetised according to a standardised protocol (n1 = 132) and those managed at clinicians’ discretion in line with good medical practice (n2 = 212). Length of hospital stay and use of intraoperative non-opioid analgesics were also assessed. Results: The total fentanyl dose administered during anaesthesia was significantly lower in the standardised protocol cohort compared to the cohort without a protocol: 3.13 μg·kg−1 (IQR: 2.98–4.08) vs. 5.19 μg·kg−1 (IQR: 3.89–6.67), p < 0.001. In the protocol cohort, the percentage of patients who received acetaminophen and metamizole was significantly higher—increasing by 57% and 23%, respectively (p < 0.001). No significant inter-cohort difference was observed in terms of length of hospital stay. Conclusions: The use of a mandatory anaesthetic protocol based on a multimodal approach had an opioid-sparing effect in children undergoing laparoscopic appendectomy. This retrospective analysis was approved by the Ethics Committee of the Medical University of Warsaw (identifier: AKBE/118/2025; date of acceptance: 12 May 2025), and the primary trial was registered in the U.S. National Library of Medicine Clinical Trials Registry (registration number: NCT05238506; date of first registration: 14 February 2022).

The purpose of this study was to compare 3 intraoperative modalities to determine the best and most convenient one for pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural, and general anesthesia alone to examine postoperative pain scores in patients. Eighty patients were enrolled and statistically analyzed. Three interventions were studied: general anesthesia with serratus plane block (group S), general anesthesia with thoracic epidural (group E), and general anesthesia only (group G). Outcome measures compared among the 3 groups included demographic characteristics; surgical types; anesthesia and operative time; postoperative pain scores; vital signs; morphine consumption at 0, 2, and 6 hours and day 1 and day 2 after surgery; incidence of opioid-related adverse events and chronic pain; hospital length of stay (LOS); and overall expenses. The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, hospital LOS, and overall hospital expenses were documented, as well as incidence of chronic postoperative pain. There was no difference in the incidence of opioid-related adverse events and chronic pain, hospital LOS, and overall expenses among the 3 groups. After investigating factors that may influence hospital LOS and overall expenses, the multivariable analysis indicated that only longer operative time was associated with longer hospital stay and more hospital expenses. This prospective study found that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses. ClinicalTrials.gov identifier: NCT03839160. (Clin Ther. 2024;XX:XXX–XXX) © 2024 Elsevier HS Journals, Inc.

Background Lidocaine, a widely used local anaesthetic, also serves as an adjuvant in pain management. However, its use in children is off-label. This study aimed to determine if intravenous lidocaine alleviates the haemodynamic, metabolic, and hormonal responses to intubation and laparoscopic surgery in children. Methods A single-centre, parallel, double-masked, randomised, placebo-controlled trial. 132 patients, aged 18 months to 18 years, with no contraindications to lidocaine administration and qualified for laparoscopic appendectomy were enrolled. The intervention studied was a lidocaine bolus of 1.5 mg⋅kg − 1 over 5 min given before induction of anaesthesia, followed by intraoperative lidocaine infusion at 1.5 mg⋅kg − 1 ⋅h − 1 intraoperatively. Patients in the control group were administered a placebo. Mean arterial pressure, glucose, cortisol, lidocaine blood levels, lidocaine-related side effects, and intraoperative opioid requirements were analysed. Results 132 participants completed the trial. The number of patients who experienced an excessive cardiovascular response to induction of anaesthesia or intubation was 23 (37%) in the control group and 21 (34%) in the lidocaine group ( p  = 0.707). No statistically significant difference was found between the control and lidocaine groups in the hormonal and metabolic responses, as well as intraoperative fentanyl requirements. Serum lidocaine levels remained below the toxic threshold in all patients. Conclusions Although the studied intervention appears to be safe, with no clinical side effects observed and serum lidocaine levels remaining below the toxic threshold, its intraoperative administration is not recommended, as it does not demonstrate any significant benefit during the anaesthesia period when compared to placebo. Trial registration number NCT05238506. The date of first registration: 14/02/2022.

Head and neck free-flap microvascular surgeries are complex and resource-intensive procedures where proper conduct of anaesthesia plays a crucial role in the outcome. Flap failure and postoperative complications can be attributed to multiple factors, whether surgical- or anaesthesia-related. The anesthesiologist should ensure optimised physiological conditions to guarantee the survival of the flap and simultaneously decrease perioperative morbidity. Institutions employ different anaesthetic techniques and results vary across centres. In our institution, two different total intravenous approaches have been in use: a remifentanil-based approach and a multimodal opioid-sparing approach, which is further divided into an opioid-free anaesthesia (OFA) subgroup. We studied every consecutive case performed between 2015 and 2022, including 107 patients. Our results show a significant reduction in overall complications (53.3 vs. 78.9%, p = 0.012), length of stay in the intensive care unit (3.43 ± 5.51 vs. 5.16 ± 4.23 days, p = 0.046), duration of postoperative mechanical ventilation (67 ± 107 vs. 9 ± 38 h, p = 0.029), and the need for postoperative vasopressors (10% vs. 46.6%, p = 0.001) in the OFA group (vs. all other patients). The multimodal and OFA strategies have multiple differences regarding the fluid therapy, intraoperative type of vasopressor used, perioperative pathways, and various drug choices compared to the opioid-based technique. Due to the small number of cases in our study, we could not isolate any attitude, as an independent factor, from the success of the OFA strategy as a whole. Large randomised controlled trials are needed to improve knowledge and help define the ideal anaesthetic management of these patients.

Background Effective postoperative pain management in patients with obesity undergoing metabolic bariatric surgery is challenging due to the adverse effects associated with opioid use. Multimodal analgesic approaches during the intraoperative period have been shown to effectively reduce postoperative opioid consumption. This study evaluated the impact of prolonged postoperative lidocaine and ketamine infusion for 90 min on postoperative morphine consumption as a complementary multimodal analgesic approach. Methods This retrospective cohort study included 64 patients who underwent elective sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). Thirty-two patients who received lidocaine and ketamine infusions postoperatively (group A) were compared with 32 patients who received standard postoperative analgesia (group B). The primary outcome measured was total morphine consumption within the first 48 h post-surgery. Pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 24, and 48 h post-surgery. Results Mean cumulative morphine consumption at 48 h was 0.82 ± 1.55 mg in group A versus 2.03 ± 2.61 mg in group B ( p  = 0.0696). In total, 62.5% of patients did not require morphine during the first 48 postoperative hours. VAS scores were significantly lower in group A at four postoperative hours (1.03 ± 1.36) compared to group B (2.16 ± 1.65) ( p  = 0.0024). Conclusions Postoperative morphine consumption and pain scores were low in the current multimodal analgesic approach. Prolonging lidocaine and ketamine infusion for 90 min postoperatively was not justified based on the current results.

The present case of a patient with several co-morbidities undergoing complex vitrectomy under peribulbar block and sedation with Target Controlled Infusion (TCI of propofol and dexmedetomidine with EEG and Analgesia Nociception Index (ANI) monitoring illustrates the benefits of multimodal monitoring to differentiate the effect of hypnotic and antinociceptive drugs.It is highlighted the delta-alpha electroencephalographic pattern showing adequate sedation, the beta arousal pattern in the EEG concommitant to decrease in the ANI translating insufficient anti-nociception.

Purpose Colorectal cancer (CRC) surgery in elderly patients with hypertension poses challenges due to potential complications and prolonged recovery. This study aimed to assess the impact of multimodal opioid-sparing anesthesia on intestinal function and prognosis of elderly hypertension patients undergoing CRC surgery. Methods A total of 80 elderly hypertension patients who underwent open surgery for CRC in the People’s Hospital of Xinjiang Uygur Autonomous Region from October 2020 to October 2022 were selected and randomly divided into two group (A and B, n  = 40) through the random number table method. Group A received multimodal opioid-sparing anesthesia, defined as low-dose opioid general anesthesia combined with a transversus abdominis plane block, incision infiltration with local anesthetics, and postoperative analgesia via a patient-controlled analgesia (PCA) pump, with the remifentanil dose set at one-third (± 10%) of the conventional group’s dose. Group B received conventional opioid anesthesia, involving standard general anesthesia maintained with remifentanil at 0.4–0.5 µg/(kg·min), incision infiltration with local anesthetics, and postoperative PCA. Primary outcomes included mean arterial pressure (MAP) and heart rate (HR), changes in albumin, C-reactive protein (CRP) and white blood cell (WBC), indicators of intestinal function recovery (the recovery time of bowel sounds, the first exhaust time, the first defecation time and the feeding recovery time), and visual analogue scale (VAS) pain scores. Second outcomes included postoperative complications and total hospital stays. Results After excluding 8 patients, 72 were included in the final analysis. Compared with patients in the B group, patients in the A group exhibited shorter recovery time of bowel sounds, first exhaust time and feeding recovery time ( P  < 0.05), higher levels of postoperative albumin, and lower levels of CRP and WBC ( P  < 0.05). Moreover, the incidence of nausea and vomiting was lower and the total hospital stays were fewer in the A group than in the B group ( P  < 0.05). Conclusion Multimodal opioid-sparing anesthesia contributes to rapid recovery of postoperative intestinal function and reduction of postoperative adverse reactions. Therefore, it is safe and feasible to apply multimodal opioid-sparing anesthesia to elderly hypertension patients receiving open surgery for CRC.

Various techniques are applied to reduce the severity of postoperative pain and discomfort in patients. The purpose of this research work was to evaluate the effectiveness and safety of Dexmedetomidine as an adjuvant of anesthesia in ophthalmic surgery. The study included 80 patients who underwent  corneal transplantation on the basis of Dnepropetrovsk Regional Clinical Ophthalmologic Hospital. Patients were divided into 2 groups: control (group K) – 30 men and main (group D) – 50 ones. Multicomponent balanced anesthesia was applied in both groups. Sibazone was administered as the sedative medicine in the group K, Dexmedetomedin was administered in the group D. The main criteria for evaluating the research results were hallmarked: hemodynamic stability during surgery, the amount of administered opiates, the severity of intraoperative pain syndrome by evaluating the ANI index (ANI – analgesia nociception index), the severity of postoperative pain syndrome and the frequency of postoperative nausea and vomiting (PONV). Both schemes of anesthesia allowed avoiding pronounced fluctuations in hemodynamic parameters and gas exchange at all stages of the study. Analyzing the severity of intraoperative pain, we found that in group K pain relief could be considered insufficient during the first 7 minutes of the most traumatic stage of the surgery, while in group D the ANI index did not fall below 50. Statistically significant differences were obtained on minute 1, 2, 5, 6, and 7 of the surgery. The number of episodes of insufficient anesthesia during the most traumatic stage of the surgery in group K was statistically significantly higher than in group D. Analyzing the quality of pain relief in the postoperative period it was determined, that the level of pain on the Visual Analog Scale (VAS) after awakening in both groups was equal to 0. At the next three stages of the study (2 hours, 6 hours after surgery, and the next morning), the level of pain in group K was significantly higher than in group D. In addition, it was determined that the need for narcotic analgesics and the number of episodes of postoperative nausea and vomiting in group K was statistically significantly higher than in group D. These given data allow us to conclude that Dexmedetomedin is the effective adjuvant of the anesthesia for corneal transplantation.

This study aimed to investigate the use of electroencephalography (EEG) for detecting brain activity changes perioperatively in anesthetized horses subjected to surgery. Twelve adult horses undergoing various surgeries were evaluated after premedication with xylazine and butorphanol, induction with ketamine, midazolam, and guaifenesin, and maintenance with isoflurane. The frontal EEG electrodes were placed after the horse was intubated and mechanically ventilated. The EEG data were collected continuously from Stage (S)1—transition from induction to isoflurane maintenance, S2—during surgery, S3—early recovery before xylazine sedation (0.2 mg kg IV), and S4—recovery after xylazine sedation. The Patient State Index (PSI), (Burst) Suppression Ratio (SR), and 95% Spectral Edge Frequency (SEF95) were compared across the stages. The PSI was lowest in S2 (20.8 ± 2.6) and increased to 30.0 ± 27.7 (p = 0.005) in S3. The SR increased from S1 (5.5 ± 10.7%) to S3 (32.7 ± 33.8%, p = 0.0001). The spectral power analysis showed that S3 had a significantly higher content of delta wave activity (0.1–4 Hz) in the EEG and lower relative power in the 3 Hz to 15 Hz range when compared to S1 and S2. A similar result was observed in S4, but the lower power was in a narrower range, from 3 Hz to 7 Hz, which indicate profound central nervous system depression potentiated by xylazine, despite the cessation of isoflurane anesthesia. We concluded that the use of EEG provides clinically relevant information about perioperative brain state changes of the isoflurane-anesthetized horse.