Study on Opioid-Free Propofol Anesthesia

A new study published in the journal of Anaesthesia found that patients having parathyroid and thyroid surgery underwent less postoperative vomiting and nausea when under opioid-free propofol anesthesia. The use of opioids for perioperative analgesia is common. Also, the postoperative hyperalgesia and increased analgesic consumption may be linked to the intraoperative administration of high bolus doses or continuous infusions of powerful opioids. Postoperative nausea and vomiting (PONV), extended sedation, ileus, and urine retention are examples of opioid-related side effects that might postpone the recovery and release or result in an unplanned return to the hospital. After thyroid and parathyroid surgery, postoperative nausea and vomiting are common and are linked to poorer patient outcomes. Thereby, Dan Wang and colleagues undertook this study to analyze if opioid-free propofol anesthesia would be less likely to cause postoperative nausea and vomiting in patients who have undergone these operations when compared to opioid-inclusive propofol anesthesia.

Study Design

At two medical facilities in mainland China, this research enrolled adult patients slated for thyroid and parathyroid surgeries. The patients were randomized 1:1, stratified by study location and sex, to either the opioid-inclusive group (sufentanil and propofol) or the opioid-free group (esketamine, lidocaine, dexmedetomidine, and propofol). Bispectral index 45 to 55 was reached by titrating propofol infusions and the patients were given multimodal analgesia with paracetamol and flurbiprofen axetil as well as prophylactic treatment for nausea and vomiting with dexamethasone and ondansetron. The prevalence of postoperative vomiting and nausea in the first 48 hours following surgery was the main result.

Results

Out of the total 557 people, nearly 394 individuals were deemed eligible for this study. The opioid-free anesthesia group (10/197, 5%) had a lower incidence of postoperative nausea and vomiting in the first 48 hours after surgery than the opioid-inclusive group (47/197, 24%). Furthermore, fewer instances of hypotension and desaturation following tracheal extubation, as well as greater patient satisfaction, were associated with opioid-free propofol anesthesia.

The opioid-free group faced a small delay in the time to tracheal extubation. The 30-day results and postoperative pain ratings for the two groups were comparable. Overall, the findings of this study found that the incidence of postoperative nausea and vomiting following thyroid and parathyroid operations was much lower when propofol anesthesia was opioid-free. Despite somewhat delayed tracheal extubation, the opioid-free regimen also resulted in lower rates of hypotension and desaturation, fewer rescue anti-emetics, and increased patient satisfaction.

Source

Wang, D., Sun, Y., Zhu, Y., Shan, X., Liu, H., Ji, F., & Peng, K. (2024). Comparison of opioid‐free and opioid‐inclusive propofol anaesthesia for thyroid and parathyroid surgery: a randomised controlled trial. In Anaesthesia. Wiley. https://doi.org/10.1111/anae.16382