Bali Journal of Anesthesiology (Jan 2024)
Multimodal Opioid-Free Anesthesia Versus Opioid-Based Anesthesia for Patients Undergoing Cardiac Valve Surgeries: A Randomized Controlled Trial
Abstract
Background: Opioid-based anesthesia (OA) is the cornerstone of cardiac anesthesia. Objectives: The aim of this study was to assess safety and efficacy of multimodal opioid-free anesthesia (OFA) regimen as an alternative to the conventional OA regimen in adult patients undergoing cardiac valve surgeries. Materials and Methods: A total of 60 patients were randomly assigned to two groups: group F (received OFA) and group O (received OA). Group F received oral pregabalin plus intravenous (IV) infusion of ketorolac, acetaminophen, dexmedetomidine, and lidocaine preoperatively. Lidocaine and dexmedetomidine were continuously infused throughout the procedure. In group O, patients received placebo in the form of oral pills plus IV infusion of normal saline preoperatively. After anesthesia induction, group F received a bolus dose of ketamine, whereas group O received fentanyl. The study outcomes were extubation time, arterial blood pressure (systolic, diastolic, and mean), heart rate (HR), visual analog scale (VAS), length of intensive care unit (ICU) stay, postoperative morphine consumption, and postoperative complications. Results: Extubation time was significantly shorter in the group F [4.5 (3–6) vs. 10 (8–12), P < 0.001]. The VAS over 24 h was also lower in group F [2 (0–3) vs. 3 (3–3.5), P < 0.001]. Furthermore, OFA was associated with significantly lower postoperative morphine intake, shorter stays in the ICU, and lower intraoperative HR and mean arterial pressure. Conclusion: In valve surgeries, a multimodal OFA regimen might be a good substitute for the standard opioid-based regimen. In addition, OFA can have the added benefit of a more rapid recovery and a shorter ICU stay, making it more feasible to be considered in patients with a history of previous opioid addiction or Parkinsonian patients.
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