Opioid-reduced anesthesia based on esketamine effective in gynecological day surgery

CHINA: Esketamine-based opioid-reduced anesthesia is practicable and gives patients efficient analgesia. According to a study published in BMC Anesthesiology, esketamine had a favorable analgesic impact and the opioid-reduced groups displayed more stable hemodynamics.

"During the perioperative phase, opioids are frequently used to relieve intraoperative and postoperative pain. Yet, there have also been severe negative side effects linked to perioperative opioid use. By minimizing opioid-related side effects, opioid-reduced anesthesia may hasten postoperative rehabilitation," Fanceng Ji, Department of Anesthesiology, People' Hospital and team stated.

The purpose of this study was to compare the typical opioid-based anesthetic program to an opioid-reduced general anesthesia program while observing postoperative nausea and vomiting (PONV), postoperative pain, hemodynamics, and other adverse responses in gynecological day surgery.

A prospective parallel-group randomized controlled trial was employed to conduct this study. There were 141 adult women who had daytime gynecological surgery in total. The opioid-reduced anesthesia (a moderate-opioid group (Group MO) and low-opioid group (Group LO) with esketamine and alfentanil) was given to patients instead of the traditional opioid-based anesthesia (Group C) with alfentanil. The three groups each received 20, 20, and 10 μg/kg of alfentanil for the induction of anesthesia, and Group LO also got an additional 0.2 mg/kg of esketamine. The patients in Group C received 40 μg/kg/h of alfentanil for anesthesia maintenance, whereas those in Group MO and Group LO received 0.5 mg/kg/h of esketamine.

Conclusive points:

• Clinical and surgical data were equivalent among the three groups of patients.
• The primary goal was achieved by 33.3% of patients in Group C, 18.4% of patients in Group MO, and 43.2% of patients in Group LO (p = 0.033).
• In Group MO, there were fewer cases of nausea within 24 hours of surgery than in Group LO (p<0.05).
• The three groups had comparable extubation times, median hospital stays following surgery, and postoperative pain scores on the visual analog scale (VAS).
• In the MO 1(0, 2) and LO 0(0, 1) groups, the frequency of unfavorable hemodynamic events was considerably reduced (p< 0.05).
• The median length of stay in the post anesthesia care unit (PACU) in Group LO was longer than in Group C, at 60.0 (36.25, 88.75) minutes as opposed to 42.5 (25, 73.75) minutes (p<0.05).

The authors noted that a large decrease in opioid use in Group LO did not lower the incidence of PONV and extended the time needed for patient rehabilitation.

They came to the conclusion that in order to give a comfortable anesthetic and a better prognosis, opioid-free anesthesia needed the combination use of several medications.

REFERENCE

Zhu, T., Zhao, X., Sun, M. et al. Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study. BMC Anesthesiol 22, 354 (2022). https://doi.org/10.1186/s12871-022-01889-x