Key result
Among cardiovascular surgery patients, opioid-free anesthesia significantly reduced post-operative nausea and vomiting compared to opioid-based anesthesia (RR 0.57; P=0.042).
Why the study?
Opioid-related complications and the ongoing opioid epidemic prompted interest in opioid-free anesthesia, but clinical outcomes compared to opioid-based anesthesia had not been pooled in cardiovascular and thoracic surgery.
Does opioid-free anesthesia reduce post-operative complications compared to opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery?
Meta-Analysis (n=919)
Does opioid-free anesthesia reduce post-operative complications compared to opioid-based anesthesia in patients undergoing cardiovascular and thoracic surgery?
Relative Risk: 0.57
p-value: p=0.042
Opioid-free anesthesia may reduce post-operative nausea, vomiting, inotrope need, and non-invasive ventilation in cardiovascular surgery patients compared to opioid-based anesthesia, though evidence is currently limited.
Suggests opioid-free anesthesia may improve early postoperative recovery profiles in cardiovascular surgery;.
Background Despite their extensive clinical use, opioids are characterized by several side effects. These complications, coupled with the ongoing opioid epidemic, have favored the rise of opioid-free-anesthesia (OFA). Herein, we perform the first pairwise meta-analysis of clinical outcomes for OFA vs opioid-based anesthesia (OBA) in patients undergoing cardiovascular and thoracic surgery. Methods We comprehensively searched medical databases to identify studies comparing OFA and OBA in patients undergoing cardiovascular or thoracic surgery. Pairwise meta-analysis was performed using the Mantel–Haenszel method. Outcomes were pooled as risk ratios (RR) or standard mean differences (SMD) and their 95% confidence intervals (95% CI). Results Our pooled analysis included 919 patients (8 studies), of whom 488 underwent surgery with OBA and 431 with OFA. Among cardiovascular surgery patients, compared to OBA, OFA was associated with significantly reduced post-operative nausea and vomiting (RR, 0.57; P = .042), inotrope need (RR .84, P = .045), and non-invasive ventilation (RR, .54; P = .028). However, no differences were observed for 24hr pain score (SMD, −.35; P = .510) or 48hr morphine equivalent consumption (SMD, −1.09; P = .139). Among thoracic surgery patients, there was no difference between OFA and OBA for any of the explored outcomes, including post-operative nausea and vomiting (RR, 0.41; P = .025). Conclusion Through the first pooled analysis of OBA vs OFA in a cardiothoracic-exclusive cohort, we found no significant difference in any of the pooled outcomes for thoracic surgery patients. Although limited to 2 cardiovascular surgery studies, OFA was associated with significantly reduced postoperative nausea and vomiting, inotrope need, and non-invasive ventilation in these patients. With growing use of OFA in invasive operations, further studies are needed to assess their efficacy and safety in cardiothoracic patients.
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Mathew et al. (2023) conducted a meta-analysis in Cardiovascular and thoracic surgery (n=919). Opioid-free anesthesia vs. Opioid-based anesthesia was evaluated on Post-operative nausea and vomiting (cardiovascular surgery patients) (RR 0.57, p=0.042). Among cardiovascular surgery patients, opioid-free anesthesia significantly reduced post-operative nausea and vomiting compared to opioid-based anesthesia (RR 0.57; P=0.042).
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