Key result
Opioid-free anesthesia linked to ~67% lower 48-hour morphine consumption versus opioid anesthesia after cardiac surgery.
Why the study?
No study had been conducted to demonstrate the feasibility of an opioid-free anesthesia protocol in cardiac surgery to improve patient care.
Does an opioid-free anesthesia protocol reduce postoperative morphine consumption in cardiac surgery patients undergoing cardiopulmonary bypass?
Case-Control (n=110)
Open-label
No
Does an opioid-free anesthesia protocol reduce postoperative morphine consumption in cardiac surgery patients undergoing cardiopulmonary bypass?
Absolute Event Rate: 5% vs 15%
p-value: p=0.001
Opioid-free anesthesia in cardiac surgery is associated with significantly reduced postoperative morphine consumption, shorter intubation times, and decreased ICU length of stay compared to opioid-based anesthesia.
May support opioid-free anaesthesia to lower morphine needs after cardiac surgery; leaves open confirmation in randomized trials.
BACKGROUND: No study has been conducted to demonstrate the feasibility of an opioid-free anesthesia (OFA) protocol in cardiac surgery to improve patient care. The aim of the present study was to evaluate the effect of OFA on post-operative morphine consumption and the post-operative course. METHODS: After retrospectively registering to clinicaltrial.gov (NCT03816592), we performed a retrospective matched cohort study (1:1) on cardiac surgery patients with cardiopulmonary bypass between 2018 and 2019. Patients were divided into two groups: OFA (lidocaine, dexamethasone and ketamine) or opioid anaesthesia (OA) (sufentanil). The main outcome was the total postoperative morphine consumption in the 48 h after surgery. Secondary outcomes were rescue analgesic use, a major adverse event composite endpoint, and ICU and hospital length of stay (LOS). RESULTS: One hundred ten patients were matched (OFA: n = 55; OA: n = 55). On inclusion, demographic and surgical data for the OFA and OA groups were comparable. The total morphine consumption was higher in the OA group than in the OFA group (15 (6-34) vs 5 mg (2-18), p = 0.001). The pain score during the first 48 post-operative hours did not differ between the two groups. Creatinine values did not differ on the first post-operative day (80 (IQR: 66-115) vs 77 mmol/l (IQR: 69-95), p = 0.284). Incidence of the composite endpoint was lower in the OFA group (25 patients (43%) vs 38 patients (68%), p = 0.021). The time to extubation and the ICU stays were shorter in the OFA group (3 (1-5) vs 5 (3-6) hours, p = 0.001 and 2 (1-3) vs 3 (2-5) days, p = 0.037). CONCLUSION: The use of OFA was associated with lower morphine consumption. OFA might be associated with shorter intubation time and ICU stays. Further randomized studies are needed to confirm these results. TRIAL REGISTRATION: This study was retrospectively registered to ct2 (identifier: NCT03816592 ) on January 25, 2019.
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Guinot et al. (2019) conducted a case-control in Cardiac surgery with cardiopulmonary bypass (n=110). Opioid-free anaesthesia (OFA) (lidocaine, dexamethasone, and ketamine) vs. Opioid anaesthesia (OA) (sufentanil) was evaluated on Total postoperative morphine consumption in the 48 hours after surgery (mg) (p=0.001). Opioid-free anaesthesia significantly reduced median total postoperative morphine consumption in the first 48 hours compared to opioid anaesthesia (5 mg vs 15 mg, p=0.001) in patients undergoing cardiac surgery.
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