Opioid-free anaesthesia and analgesia – Tribute to fashion or the imperative of time?

Abstract

Opioid analgesia continues to be the “gold standard” of postoperative analgesia in most developed countries. At the same time, in recent years, evidence has been accumulated indicating the negative impact of opioids on the course of the early postoperative period. In addition to the traditional side effects of these drugs (depression of consciousness, excessive sedation, nausea, etc.), their ability to form opioid-induced hyperalgesia, to have an immunosuppressive effect, to reduce the power of local anesthetics is considered. In addition, opioid analgesia prevents the implementation of the concept of accelerated postoperative patient rehabilitation (fast-track surgery and ERAS). The review examines the modern possibilities of conducting free or low-opioid anesthesia, mainly during laparoscopic surgery. The concept of multimodal analgesia makes it possible to refuse the use of opioid analgesics or to minimize their dosage in the perioperative period. Multimodal analgesia involves the simultaneous administration of two or more drugs that affect different levels of the formation of acute pain. The characteristics of the main components of opioid-free anesthesia and analgesia (NSAIDs, paracetamol, dexmedetomidine, gabapentin, ketamine, lidocaine, dexamethasone) are described from the standpoint of evidence-based medicine. The schemes of opioid-free anesthesia and analgesia in a number of surgeries are presented, in particular, with laparoscopic cholecystectomy and laparoscopic hemicolectomy.