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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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12.10.2022 | Reports of Original Investigations

Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study

verfasst von: Andres Zorrilla-Vaca, MD, Pedro T. Ramirez, MD, Maria Iniesta-Donate, MD, PhD, Javier D. Lasala, MD, Xin Shelley Wang, MD, MPH, Loretta A. Williams, MSN, PhD, RN, Larissa Meyer, MD, MPH, Gabriel E. Mena, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2022

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Abstract

Purpose

Dexmedetomidine and ketamine may be administered intraoperatively as continuous infusions to provide opioid-sparing anesthesia. Recent evidence has yielded controversial results regarding the impact of opioid-free anesthesia on postoperative complications, and there is a gap in knowledge regarding patient-reported outcomes (PROs). This study aimed to determine the impact of opioid-sparing anesthesia and opioid-based anesthesia on PROs among gynecologic patients within an enhanced recovery after surgery (ERAS) program.

Methods

We formed a single-center historical cohort from patients enrolled in another study who underwent open gynecologic surgery on an ERAS program from November 2014 to December 2020 (n = 2,095). We identified two cohorts based on the type of balanced anesthesia administered: 1) opioid-sparing anesthesia defined as the continuous infusion of dexmedetomidine and ketamine (adjuvants) during surgery or 2) opioid-based anesthesia (no adjuvants). We measured the quality of postoperative recovery using the MD Anderson Symptom Inventory (MDASI), a 29-item validated tool that was administered preoperatively, daily while admitted, and weekly after discharge until week 6. The primary outcome was interference with walking. We matched both cohorts and used a multilevel linear mixed-effect model to evaluate the effect of opioid-sparing anesthesia on the primary outcome.

Results

In total, 498 patients were eligible (159 in the opioid-sparing anesthesia cohort and 339 in the opioid-based anesthesia cohort), of whom 149 matched pairs were included in the final analysis. Longitudinal assessment showed no significant or clinically important difference in interference with walking (P = 0.99), general activity (P = 0.99), or other PROs between cohorts. Median [interquartile range (IQR)] intraoperative opioid administration (expressed as morphine milligram equivalents [MME]) among matched patients in the opioid-sparing anesthesia cohort was 30 [25–55] mg vs 58 [8–70] mg in the opioid-based anesthesia cohort (P < 0.01). Patients in the opioid-sparing anesthesia cohort had a lower opioid consumption in the postanesthesia care unit than those in the opioid-based anesthesia cohort (MME, 3 [0–10] mg vs 5 [0–15] mg; P < 0.01), but there was no significant difference between cohorts in total postoperative opioid consumption (MME, 23 [0–94] mg vs 35 [13–95] mg P = 0.053).

Conclusions

In this single-center historical cohort study, opioid-sparing anesthesia had no significant or clinically important effects on interference with walking or other PROs in patients undergoing gynecologic surgery compared with opioid-based anesthesia. Opioid-sparing anesthesia was associated with less short-term opioid consumption than opioid-based anesthesia.

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Titel: Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study
verfasst von: Andres Zorrilla-Vaca, MD
Pedro T. Ramirez, MD
Maria Iniesta-Donate, MD, PhD
Javier D. Lasala, MD
Xin Shelley Wang, MD, MPH
Loretta A. Williams, MSN, PhD, RN
Larissa Meyer, MD, MPH
Gabriel E. Mena, MD
Publikationsdatum: 12.10.2022
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02336-8

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Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study

Abstract

Purpose

Methods

Results

Conclusions

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Purpose

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Results

Conclusions

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