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EVALUATIOF EFFICACY OF FREE OPIOID ANESTHESIA FOR COLORECTAL SURGERY: A PROSPECTIVE RANDOMIZED CONTROLLED CLINICAL TRIAL
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Abstract
Objectives: To compare the intraoperative analgesic effect of general anesthesia with or without opioids for colorectal resection surgery. Methods: A randomized clinical trial study was carried on 98 patients who underwent colorectal surgery. The patients were divided into opioid anesthesia group (OA group, n = 49) and opioid free anesthesia group (FOA group, n = 49). Intraoperative pain management in OA and FOA group was taken with fentanyl intravenous route and lidocaine, ketamine intravenous infusion combined with continuous epidural infusion by evobupivacaine, respectively. Pulse rate, mean arterial blood pressure, anesthesia level, surgical pleth index (SPI) were collected at time points: pre-anesthesia (T1), after endotracheal (T4), after skin incision (T6), Colon/rectal release (T7), colon/rectectomy (T9), restores gastrointestinal tract (T10), after closing skin incision (T13), eyes opening (T14). Results: The differences of heart rate and mean arterial blood pressure between OA and FOA groups were not significant at all time points. Surgical pleth index (SPI) for pain assessment during surgery from T4 to T13 point also had no difference between two groups with p > 0.05. The mean of pain adjustment times of FOA group (0.29 ± 0.54) was significantly lower than OA group (0.88 ± 0.83), p = 0,0000. Compared with the OA group, the FOA group had a significantly lower extubation time as duration to reach 10 points of Aldrete score and flatus time (p < 0.05). The ratio of nausea, vomiting and the need to use ondansetron in the FOA group were significantly lower than that in OA group (p < 0.05). Conclusion: Non-opioid anesthesia achieves an effective pain relief for colorectal surgery with the same SPI to opioid group. The number of pain adjustments was lower, the time to extubation and the time to flatus were shorter compared to the opioid group. The rate of side effects was lower than in the opioid group. The rate of side effects was lower than opioid group.
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References
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