Opioid-free versus Opioid-Based General Anesthesia in Cesarean Sections: A Cross-sectional Analysis

Abstract

Aim:Guidelines recommend opioid-free (OF) anesthesia in elective cesarean sections (CS). However, opioids are commonly administered after a baby’s delivery for postoperative pain in daily practice. Our aim was to compare OF and opioid-based (OB) general anesthesia in elective surgery (CS).Methods:The study was a cross-sectional study including patients who had undergone elective CS with OF (Group OF) and OB (Group OB) general anesthesia between June 1, 2022, and November 30, 2022. Intraoperatively administered analgesics for postoperative pain mainly included acetaminophen and non-steroidal anti-inflammatory drugs (NSAID) in Group OF and fentanyl, acetaminophen, and tramadol in Group OB. Non-steroidal anti-inflammatory drugs were administered as analgesics at the maternity ward.Results:Of 368 patients, 278 were excluded due to regional anesthesia. In 90 patients, 45 were in Group OF and 45 were in Group OB. Group OF received less intraoperative fluid compared with Group OB. Two groups required a similar number of NSAIDs on postoperative day zero. Group OF had more NSAID consumption on postoperative days one and two.Conclusion:Opioid-free general anesthesia did not change the required number of NSAIDs 24 hours after surgery and necessitated less intraoperative crystalloid fluid. Our study supports Enhanced recovery after surgery protocols, which recommend multimodal analgesics and sparing opioids in CS, and adds to the accumulating evidence that suggests the use of OF general anesthesia in CS.

Keywords

• obstetrics
• cesarean section
• general anesthesia
• opioid analgesics
• postoperative pain
• perioperative care