Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study.

BACKGROUND: Few studies have investigated the depth of intraoperative analgesia with non-opioid anesthesia. This study evaluated whether opioid-free anesthesia can provide an effective analgesia-antinociception balance monitored by the / pain threshold index in laparoscopic radical colectomy. METHODS: We enrolled 102 patients undergoing laparoscopic radical colectomy with general anesthesia. Participants were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine (loading dose with 0.6 µg·kg-1 for 10 min and then 0.5 µg·kg-1·h-1 continuous infusion) and sevoflurane plus bilateral paravertebral blockade (0.2 µg·kg-1 dexmedetomidine and 0.5% ropivacaine 15 ml per side) or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and bilateral paravertebral blockade (0.5% ropivacaine 15 ml per side). The primary outcome variable was pain intensity during the operation, as assessed by the pain threshold index with the multifunction combination monitor HXD- I. Results were analyzed using repeated measures analysis of variance and Student's t-test. The secondary outcomes were wavelet index, lactic levels, and blood glucose concentration during the operation. The visual analog scale (VAS), rescue analgesic consumption, and side-effects of opioids after surgery were further assessed. RESULTS: One hundred and one patients were included in the analysis. Analysis revealed that the intraoperative pain threshold index readings were not significantly different between the groups from incision to the end of the operation (P = 0.06). Furthermore, similar changes in the brain wavelet index readings were observed in the OFA and OA groups. There was no statistical difference in VAS scores between the groups (P > 0.05); however, non-opioid anesthesia did reduce the rescue analgesic consumption after operation (P < 0.05). In the OFA group, the blood glucose levels increased by 20% compared to baseline and were significantly higher than those in the OA group (P < 0.001). The incidences of postoperative nausea and vomiting, urine retention, intestinal paralysis and pruritus were not significantly different from those in the OA group (P > 0.05). CONCLUSIONS: This study suggests that compared to the opioid anesthesia regimen, our opioid-free anesthesia regimen achieved an equally effective intraoperative pain threshold index in laparoscopic radical colectomy. The incidence of opioid-related adverse reactions was not different between regimens, and intraoperative blood glucose levels were higher with opioid-free anesthesia. TRIAL REGISTRATION: ChiCTR1900021223, 02/02/2019, Title: " Opioid-free anesthesia in laparoscopic surgery: a randomized controlled trial ". Website: hppts:// www.chictr.ogr.cn.

Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: A randomized controlled study.

BACKGROUND: Reducing intra-operative opioid consumption benefits patients by decreasing postoperative opioid-related adverse events. We assessed whether opioid-free anesthesia would provide effective analgesia-antinociception monitored by analgesia index in video-assisted thoracoscopic surgery. METHODS: Patients (ASA Ⅰ-Ⅱ, 18-65 years old, BMI <30 kg m-2) scheduled to undergo video-assisted thoracoscopic surgery under general anesthesia were randomly allocated into two groups to receive opioid-free anesthesia (group OFA) with dexmedetomidine, sevoflurane plus thoracic paravertebral blockade or opioid-based anesthesia (group OA) with remifentanil, sevoflurane, and thoracic paravertebral blockade. The primary outcome variable was pain intensity during the operation, assessed by the depth of analgesia using the pain threshold index with the multifunction combination monitor HXD­I. Secondary outcomes included depth of sedation monitoring by wavelet index and blood glucose concentration achieved from blood gas. RESULTS: One hundred patients were randomized; 3 patients were excluded due to discontinued intervention and 97 included in the final analysis. Intraoperative pain threshold index readings were not significantly different between group OFA and group OA from arriving operation room to extubation (P = 0.86), while the brain wavelet index readings in group OFA were notably lower than those in group OA from before general anesthesia induction to recovery of double lungs ventilation (P <0.001). After beginning of operation, the blood glucose levels in group OFA increased compared with baseline blood glucose values (P < 0.001). The recovery time and extubation time in group OFA were significantly longer than those in group OA (P <0.007). CONCLUSIONS: This study suggested that our OFA regimen achieved equally effective intraoperative pain threshold index compared to OA in video-assisted thoracoscopic surgery. Depth of sedation was significantly deeper and blood glucose levels were higher with OFA. Study's limitations and strict inclusion criteria may limit the external validity of the study, suggesting the need of further randomized trials on the topic. Trial registration: ChiCTR1800019479, Title: "Opioid-free anesthesia in video-assisted thoracoscopic surgery lobectomy".

[Effects of preoperative carbohydrate loading on the changes in serum tumor necrosis factor receptors 1 and 2 and insulin resistance in patients of colon carcinoma].

OBJECTIVE: To investigate the effects of preoperative carbohydrate loading and new fasting protocol treatment on the postoperative changes in serum tumor necrosis factor receptor1 (sTNFR1), sTNFR2, and insulin resistance (IR) in patients of colon carcinoma. METHODS: 51 patients of colon carcinoma were randomly divided into 2 groups: carbohydrate-rich beverage group (n = 24), undergoing fasting 6 h before operation and water deprivation 2 h before operation, receiving carbohydrate-rich beverage 3 h before operation and fluid therapy with glucose post-operatively, and placebo group (n = 27) undergoing routine fasting and water deprivation pre-operatively. Peripheral blood samples were collected before, during, and 1, 4, and 7 d after operation. ELISA was used to detect the sTNFR1 and sTNFR2 of preoperative, 1, 4, 7day Insulin sensitivity index (S1) was calculated. RESULTS: The S(1) levels at different post-operational time points of the treatment group were not significantly different from those preoperatively (all P > 0.05), while the S(1) levels of the control group decreased significantly compared to those before operation (all P < 0.05). The sTNFR1 level of the treatment group increased postoperatively and did not return to the pre-operative level 7 d after operation(all P < 0.05). The sTNFR1 levels at different post-operative time points of the treatment group were all significantly higher than those of the control group (all P < 0.05). The sTNFR2 level of the treatment group decreased postoperatively and did not return to the pre-operative level 7d after operation (all P < 0.05). The sTNFR2 levels at different post-operative time points of the treatment group were all significantly lower than those of the control group (all P < 0.05). There was not significant differences in the sTNFR1 level in the control group before and after operation (all P > 0.05). The time to first flatus and days staying in hospital of the treatment group were (77 +/- 15) hours and (11 +/- 1.2) gays respectively, both significantly shorter than those of the control group [(86 +/- 13) hours and (15.1 +/- 3.8) days respectively, both P < 0.05]. CONCLUSION: Preoperative carbohydrate loading and new fasting protocol reduce the degree and course of IR, increase the sTNFR1 level, and decrease the sTNFR2 level and days of staying in hospital.