Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial
Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperat...
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Published in | Frontiers in oncology Vol. 13; p. 1145953 |
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Abstract | Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery.
Sixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward.
There was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (
=0.001) and a lower incidence of hypotension (
=0.004) during surgery. The OFA group resumed spontaneous respiration faster (
<0.001) and had a higher quality of lung collapse (
=0.02). However, the total doses of propofol and dexmetomidine were higher (
=0.03 and
=0.02), and the time to consciousness was longer (
=0.039) in the OFA group.
OFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS. |
---|---|
AbstractList | Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery.
Sixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward.
There was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (
=0.001) and a lower incidence of hypotension (
=0.004) during surgery. The OFA group resumed spontaneous respiration faster (
<0.001) and had a higher quality of lung collapse (
=0.02). However, the total doses of propofol and dexmetomidine were higher (
=0.03 and
=0.02), and the time to consciousness was longer (
=0.039) in the OFA group.
OFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS. BackgroundOpioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery. MethodsSixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward. ResultsThere was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine (P=0.001) and a lower incidence of hypotension (P=0.004) during surgery. The OFA group resumed spontaneous respiration faster (P<0.001) and had a higher quality of lung collapse (P=0.02). However, the total doses of propofol and dexmetomidine were higher (P=0.03 and P=0.02), and the time to consciousness was longer (P=0.039) in the OFA group. ConclusionsOFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS. Background Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation video-assisted thoracic surgery (SV-VATS) has not been demonstrated. We aimed to investigate the hypothesis that OFA could provide the same perioperative pain control as opioid anesthesia (OA), maintain safe and stable respiration and hemodynamics during surgery, and improve postoperative recovery. Methods Sixty eligible patients (OFA group: n=30; OA group: n=30) treated between September 15, 2022, and December 15, 2022, at The First Hospital of Guangzhou Medical University were included. They were randomized to receive standard balanced OFA with esketamine or OA with remifentanil combined with sufentanil. The primary outcome was the pain numeric rating score (NRS) at postoperative 24 h, and the secondary outcomes were intraoperative respiratory and hemodynamic data, opioid consumption, vasoactive drug dosage, and recovery in the post-anesthesia care unit and ward. Results There was no significant difference in the postoperative pain scores and recovery quality between the two groups. The OFA group had a significantly lower dose of phenylephrine ( P =0.001) and a lower incidence of hypotension ( P =0.004) during surgery. The OFA group resumed spontaneous respiration faster ( P <0.001) and had a higher quality of lung collapse ( P =0.02). However, the total doses of propofol and dexmetomidine were higher ( P =0.03 and P =0.02), and the time to consciousness was longer ( P =0.039) in the OFA group. Conclusions OFA provides the same level of postoperative pain control as OA, but it is more advantageous in maintaining circulatory and respiratory stability and improving the quality of pulmonary collapse in SV-VATS. |
Author | Zhang, Xin Zhou, Qianling Jiang, Long Li, Jiayang Fan, Qisen Luo, Jinhui Lan, Lan Zhang, Yaoliang |
AuthorAffiliation | 1 Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China 3 National Clinical Research Center for Respiratory Disease and Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China 2 Department of Medical Imaging, Guangdong Second Provincial General Hospital , Guangzhou , China |
AuthorAffiliation_xml | – name: 2 Department of Medical Imaging, Guangdong Second Provincial General Hospital , Guangzhou , China – name: 1 Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China – name: 3 National Clinical Research Center for Respiratory Disease and Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University , Guangzhou , China |
Author_xml | – sequence: 1 givenname: Qisen surname: Fan fullname: Fan, Qisen organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 2 givenname: Jinhui surname: Luo fullname: Luo, Jinhui organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 3 givenname: Qianling surname: Zhou fullname: Zhou, Qianling organization: Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China – sequence: 4 givenname: Yaoliang surname: Zhang fullname: Zhang, Yaoliang organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 5 givenname: Xin surname: Zhang fullname: Zhang, Xin organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 6 givenname: Jiayang surname: Li fullname: Li, Jiayang organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 7 givenname: Long surname: Jiang fullname: Jiang, Long organization: National Clinical Research Center for Respiratory Disease and Departments of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China – sequence: 8 givenname: Lan surname: Lan fullname: Lan, Lan organization: Department of Anesthesia, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China |
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Cites_doi | 10.1016/j.athoracsur.2019.01.013 10.1016/j.athoracsur.2019.04.052 10.21037/jtd-20-3039 10.1111/aas.13054 10.1001/jama.2017.2297 10.3390/jcm11236955 10.1213/ANE.0b013e31820568af 10.1186/s12931-022-02250-z 10.1213/ANE.0b013e3181de0ab6 10.1016/j.bja.2019.05.043 10.1016/S0140-6736(16)31719-6 10.2147/JPR.S373412 10.1016/S2213-2600(18)30294-7 10.1016/S1470-2045(16)00173-X 10.1097/EJA.0000000000001216 10.1016/j.bpa.2017.07.001 10.1097/ALN.0000000000003572 10.1213/ANE.0000000000002497 10.1097/ALN.0000000000003529 10.1016/j.athoracsur.2007.01.049 10.21037/atm-20-6125 10.1016/j.jtcvs.2021.01.093 10.1016/j.accpm.2022.101089 10.1093/ejcts/ezz279 10.1016/j.bpa.2019.09.002 10.21037/tlcr-21-629 10.1111/anae.15245 10.1186/s12871-020-01098-4 10.1097/ALN.0000000000003725 10.1093/bja/aeu090 10.1111/anae.15288 |
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Copyright | Copyright © 2023 Fan, Luo, Zhou, Zhang, Zhang, Li, Jiang and Lan. Copyright © 2023 Fan, Luo, Zhou, Zhang, Zhang, Li, Jiang and Lan 2023 Fan, Luo, Zhou, Zhang, Zhang, Li, Jiang and Lan |
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Keywords | opioid-free anesthesia mechanical ventilation spontaneous ventilation opioid anesthesia video-assisted thoracic surgery |
Language | English |
License | Copyright © 2023 Fan, Luo, Zhou, Zhang, Zhang, Li, Jiang and Lan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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PublicationTitle | Frontiers in oncology |
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Snippet | Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation... Background Opioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous... BackgroundOpioid-free anesthesia (OFA) provides adequate analgesia and can reduce postoperative opioid consumption, but its efficacy in spontaneous ventilation... |
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StartPage | 1145953 |
SubjectTerms | mechanical ventilation Oncology opioid anesthesia opioid-free anesthesia spontaneous ventilation video-assisted thoracic surgery |
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Title | Esketamine opioid-free intravenous anesthesia versus opioid intravenous anesthesia in spontaneous ventilation video-assisted thoracic surgery: a randomized controlled trial |
URI | https://www.ncbi.nlm.nih.gov/pubmed/37324000 https://search.proquest.com/docview/2827255349 https://pubmed.ncbi.nlm.nih.gov/PMC10266098 https://doaj.org/article/449556e6ef9b4714aa77eb3feb89fd85 |
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