Anest. intenziv. Med. 2022;33(1):25-31 | DOI: 10.36290/aim.2022.002

The principles of opioid­‑free anesthesia and postoperative analgesia, our experience in bariatric surgeryReview Article

Píza P., Uchytilová E., Čermáková A., Kieslichová E.

Klinika anesteziologie, resuscitace a intenzivní péče, Transplantcentrum, Institut klinické a experimentální medicíny, Praha

Opioid-free anaesthesia and postoperative analgesia are methods of perioperative care without the use of opioids, whereas the principles of opioid-sparing anaesthesia and postoperative analgesia lie in the use of opioids in minimal doses. These methods are based on multimodal approach and reduce the influence of opioid side-effects on postoperative course. Within general opiod-free anaesthesia and systemic postoperative analgesia a combination of adjuvant, non-opioid analgetics and non-steroidal antiinflammatory drugs is used, which enables to reduce opioid consumption and the incidence of opioid side effects. NMDA receptor antagonists, local anaesthetics and α₂-receptor agonists are the most frequenly used drugs. Benefit of opioid-free anaethesia and analgesia was primarily shown in patients, for whom opioid side-effects mean significant risk of postoperative complications, for example morbidly obese patients undergoing bariatric surgical procedures. In our institute opioid-free approach proved to be effective and beneficial in patients undergoing laparoscopic assisted sleeve gastrectomies. Even though it is not possible to recommend opioid-free anaesthesia and analgesia as a method of choice in general, opioid-sparing approach is a fixed part of guidelines for anaesthesia and postoperative analgesia in risk patients, who are seriously endangered by opioid side-effects.

Keywords: opioid­‑free anaesthesia, opioid­‑sparing anaesthesia, mulimodal systemic analgesia, opioids.

Received: November 11, 2021; Revised: January 5, 2022; Accepted: January 11, 2022; Published: February 25, 2022  Show citation