Opioid-free anesthesia significantly reduced total perioperative opioid consumption compared to opioid-containing anesthesia (2.43 vs 38.13 oral morphine equivalents, p<0.001) in patients undergoing minimally invasive lumbar decompression.
Cohort (n=36)
No
Does an opioid-free anesthesia regimen reduce perioperative opioid consumption compared to traditional opioid-containing anesthesia in patients undergoing lumbar decompressive surgery?
Opioid-free anesthesia within an ERAS pathway for lumbar spinal decompression significantly reduces perioperative opioid exposure without adversely affecting pain control or recovery.
Absolute Event Rate: 2.43% vs 38.125%
p-value: p=<0.001
OBJECTIVEEnhanced recovery after surgery (ERAS) and multimodal analgesia are established care models that minimize perioperative opioid consumption and promote positive outcomes after spine surgery. Opioid-free anesthesia (OFA) is an emerging technique that may achieve similar goals. The purpose of this study was to evaluate an OFA regimen within an ERAS pathway for lumbar decompressive surgery and to compare perioperative opioid requirements in a matched cohort of patients managed with traditional opioid-containing anesthesia (OCA).METHODSThe authors performed a retrospective analysis of prospectively collected data. They included 36 patients who underwent lumbar decompression under their ERAS pathway for spinal decompression between February and August 2018. Eighteen patients who received OFA were matched in a 1:1 ratio to a cohort managed with a traditional OCA regimen. The primary outcome was total perioperative opioid consumption. Postoperative pain scores (measured using the numerical rating scale NRS), opioid consumption (total morphine equivalents), and length of stay (time to readiness for discharge) were compared in the postanesthesia care unit (PACU). The authors also assessed compliance with ERAS process measures and compared compliance during 3 phases of care: pre-, intra-, and postoperative.RESULTSThere was a significant reduction in total perioperative opioid consumption in patients who received OFA (2.43 ± 0.86 oral morphine equivalents OMEs; mean ± SEM), compared to patients who received OCA (38.125 ± 6.11 OMEs). There were no significant differences in worst postoperative pain scores (NRS scores 2.55 ± 0.70 vs 2.58 ± 0.73) or opioid consumption (5.28 ± 1.7 vs 4.86 ± 1.5 OMEs) in the PACU between OFA and OCA groups, respectively. There was a clinically significant decrease in time to readiness for discharge from the PACU associated with OFA (37 minutes), although this was not statistically significantly different. The authors found high overall compliance with ERAS process measures (91.4%) but variation in compliance according to phase of care. The highest compliance occurred during the preoperative phase (94.71% ± 2.88%), and the lowest compliance occurred during the postoperative phase of care (85.4% ± 5.7%).CONCLUSIONSOFA within an ERAS pathway for lumbar spinal decompression represents an opportunity to minimize perioperative opioid exposure without adversely affecting pain control or recovery. This study reveals opportunities for patient and provider education to reinforce ERAS and highlights the postoperative phase of care as a time when resources should be focused to increase ERAS adherence.
Soffin et al. (Mon,) conducted a cohort in Minimally invasive lumbar spine surgery (n=36). Opioid-free anesthesia vs. Opioid-containing anesthesia was evaluated on Total perioperative opioid consumption (oral morphine equivalents) (p=<0.001). Opioid-free anesthesia significantly reduced total perioperative opioid consumption compared to opioid-containing anesthesia (2.43 vs 38.13 oral morphine equivalents, p<0.001) in patients undergoing minimally invasive lumbar decompression.