Three interesting recent studies looking at specific choices around anaesthetic technique. In the Canadian Journal of Anesthesia, da Silveira reviews the benefits of opioid-free laparoscopic surgery; in the Journal of Cardiothoracic and Vascular Anesthesia, Ford goes deep on the pros and cons of different anaesthetic techniques for AF ablation procedures; and finally in the JCA, Liu reports on a single-centre RCT investigating the beneficial effects of LMAs on atelectasis.
Opioid-Free Laparoscopic Surgery: Less Nausea, Similar Pain Control
An interesting meta-analysis from da Silveira et al. explores whether we can effectively manage minimally invasive abdominal surgery without using opioids - an important question given how common opioid-related side effects are.
This was a comprehensive systematic review and meta-analysis of 26 randomised controlled trials, including 2,025 patients. The researchers specifically compared opioid-free versus opioid-containing anesthesia in minimally invasive abdominal surgeries. They were particularly interested in looking at side effects like PONV and bradycardia, as well as pain control and recovery times.
The results were quite interesting. The authors found that opioid-free anaesthesia:
- Reduced PONV by 45% (from 24% to 13% / RR CI 0.40 to 0.74).
- Led to slightly lower immediate postoperative pain scores (though not clinically significant).
- Required less postoperative opioid use in the first 2 hours.
- Showed no difference in recovery room length of stay.
- Showed no increase in bradycardia, a previously noted concern when using intraoperative dexmedetomidine.