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opioid free anaesthesia

Chitra Garg, Sangeeta Khanna, Yatin Mehta
Abdominal field blocks are commonly used as part of multimodal analgesia for post-operative pain relief in patients undergoing abdominal surgery. Conventionally, transversus abdominis plane block is used, but has the disadvantage of limited spread only to T10-T12 segments, providing only partial pain relief. The new quadratus lumborum (QL) block has the advantage of providing wider sensory block from T6 to L1 and thus has an evolving role in opioid-free anaesthesia. Opioid-induced cough depression, urinary retention, and drowsiness can be problematic in patients with Prune belly syndrome, who have deficient abdominal muscles and myriad of genitourinary problems...
October 2017: Indian Journal of Anaesthesia
Donna M White, Alastair R Mair, Fernando Martinez-Taboada
Opioid-free anaesthesia (OFA) is a relatively new and growing field in human medicine. There are multiple motivations behind this emerging practice with the recognition of several serious potential opioid-related adverse effects including opioid induced hyperalgesia, opioid tolerance and immunomodulatory effects of opioids. Opioids have long been the mainstay of veterinary anaesthesia and pain management practice. The feasibility of OFA in veterinary patients is presented here. A case series of three dogs that underwent OFA for canine ovariohysterectomy is reported...
2017: Open Veterinary Journal
Jason W Boland, A Graham Pockley
In patients with cancer, opioids are principally used for the management of acute surgical and chronic cancer-related pain. However, opioids have many non-analgesic effects, including direct and indirect effects on cancer cells and on anti-tumour immunity (NK cells, macrophages and T-cells). Direct effects on immune cells are manifested via opioid and non-opioid toll-like receptors, whereas indirect effects are manifested via the sympathetic nervous system and hypothalamic-pituitary-adrenal axis. Opioids can also decrease/alter immune cell infiltration into the tumour micro-environment...
June 8, 2017: British Journal of Pharmacology
Nomaqhawe Moyo, Farai D Madzimbamuto, Samson Shumbairerwa
BACKGROUND: The current gold standard treatment for acute postoperative pain after major abdominal surgery is multimodal analgesia using patient controlled analgesia delivery systems. Patient controlled analgesia systems are expensive and their routine use in very low income countries is not practical. The use of ultrasound in anaesthesia has made some regional anaesthesia blocks technically easy and safe to perform. This study aimed to determine whether adding an ultrasound guided transversus abdominis plane block as an adjunct to the current parenteral opioid based regimen would result in superior pain relief after a trans abdominal hysterectomy compared to using parenteral opioids alone...
January 28, 2016: BMC Research Notes
Ozlem S Cakmakkaya, Kerstin Kolodzie, Christian C Apfel, Nathan Leon Pace
BACKGROUND: Surgery remains a mainstay of treatment for malignant tumours; however, surgical manipulation leads to a significant systemic release of tumour cells. Whether these cells lead to metastases is largely dependent on the balance between aggressiveness of the tumour cells and resilience of the body. Surgical stress per se, anaesthetic agents and administration of opioid analgesics perioperatively can compromise immune function and might shift the balance towards progression of minimal residual disease...
November 7, 2014: Cochrane Database of Systematic Reviews
T F Bendtsen, E M Pedersen, S Haroutounian, K Søballe, B Moriggl, L Nikolajsen, J B Hasselstrøm, A K Fisker, J M C Strid, B Iversen, J Børglum
Surgical anaesthesia with haemodynamic stability and opioid-free analgesia in fragile patients can theoretically be provided with lumbosacral plexus blockade. We compared a novel ultrasound-guided suprasacral technique for blockade of the lumbar plexus and the lumbosacral trunk with ultrasound-guided blockade of the lumbar plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal lumbar plexus nerves compared with a lumbar plexus block, and more effective for anaesthesia of the lumbosacral trunk...
November 2014: Anaesthesia
S N Shrestha, B Bhattarai, R Shah
BACKGROUND: Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia. OBJECTIVES: The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine. METHODS: One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups...
October 2013: Kathmandu University Medical Journal (KUMJ)
Zhi-Yang Chen, Huaqing Wang, Weiping Xu, Hui Xu, Xinchun Fu
OBJECTIVE: To measure the plasma concentrations of three endogenous opioid peptides and the levels of preproenkephalin (PPE) and preprodynorphin (PPD) mRNA in peripheral blood lymphocytes of patients during scheduled surgery performed under intravenous general anaesthesia combined with an epidural block. METHODS: Patients were anaesthetized and arterial blood was collected at 0 (baseline), 20, 40, 60, and 80 min during surgery. The plasma concentrations of β-endorphin, leucine-enkephalin and dynorphin A were measured using radioimmunoassay...
June 2014: Journal of International Medical Research
M Roiss, J Schiffmann, P Tennstedt, T Kessler, I Blanc, A Goetz, T Schlomm, M Graefen, D A Reuter
INTRODUCTION: Recent data suggest that using additional neuroaxial anaesthesia during oncological surgery is associated with favourable recurrence-free survival, when compared with general anaesthesia alone. We assessed the impact of adjunctive perioperative spinal anaesthesia and dose of opioids on the oncological long-term outcome of patients following radical prostatectomy. METHODS: We selected patients from our institutional review board-approved database who consecutively underwent radical prostatectomy between 2002 and 2007...
December 2014: European Journal of Surgical Oncology
P Ziemann-Gimmel, A A Goldfarb, J Koppman, R T Marema
BACKGROUND: Patients undergoing bariatric surgery are at high risk of postoperative nausea and vomiting (PONV). Despite triple PONV prophylaxis, up to 42.7% of patients require antiemetic rescue medication (AERM). METHODS: This prospective, randomized study was conducted from November 2011 to October 2012. In the Classic group (n=59), patients underwent general anaesthesia with volatile anaesthetics and opioids. In the Total i.v. anaesthesia (TIVA) group (n=60), patients underwent opioid-free TIVA with propofol, ketamine, and dexmedetomidine...
May 2014: British Journal of Anaesthesia
Leopold Eberhart, Astrid Morin, Peter Kranke
Postoperative nausea and vomiting are undesirable and unpleasant side effects after surgery and anaesthesia associated with delayed oral intake and postoperative recovery, and impaired parental satisfaction. Since current modalities against PONV are cheap, highly effective, and almost free from relevant side-effects - providing contraindications are appropriately considered -, recommendations tend to move away from risk-score guided administration of antiemetic towards a more liberal administration policy or even favour routine administration to children undergoing general anaesthesia for surgery combined with total-intrevanous anaesthesia using propfol and reduction of perioperative opioid administration...
January 2014: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
V D Ward, C R Mc Crory
BACKGROUND: Intrathecal opioid administration yields high quality analgesia with an associated low incidence of side effects and complication. The benefits of spinal "opioid only technique" include absence of neuronal blockade, infusion pump malfunction and sympathetic blockade. This technique declined after serious side effects were reported in the 1990s. AIMS: To report on the safety and efficacy of the intrathecal catheter repeat bolus morphine technique for postoperative analgesia in patients having thoracotomy...
June 2014: Irish Journal of Medical Science
Y Wang, D Hackel, F Peng, H L Rittner
BACKGROUND: Electroacupuncture (EA) has been widely accepted and applied as an important acupuncture-related technique for acupuncture analgesia (AA) research. The involvement of opioid peptides and receptors in acute AA has been shown via pre-EA application of opioid receptor/peptide antagonists. In this study, we intended to reproducibly institute acupoint position and needling excluding influences from anaesthesia or restrainers on rats with complete Freund's adjuvant (CFA) hind paw inflammatory pain, as well as to explore opioid-dependency and anti-inflammatory effects in sustained acupuncture analgesia...
November 2013: European Journal of Pain: EJP
K L Dorrington, W Poole
Our speciality commonly traces its origin to a demonstration of the inhalation of ether by a patient undergoing surgery in Boston in 1846. Less well known is the demonstration of the i.v. injection of opium with alcohol into a dog in Oxford in 1656, leading to anaesthesia followed by full long-term recovery. After gaining i.v. access, a mixture of opium and alcohol was injected, resulting in a brief period of anaesthesia. After a period during which the dog was kept moving to assist recovery, a full recovery was made...
January 2013: British Journal of Anaesthesia
Theodoros Tosounidis, Nikolaos Kanakaris, Vasilios Nikolaou, Boon Tan, Peter V Giannoudis
PURPOSE: We performed a prospective study to document, by intra-operative manipulation under anaesthesia (MUA) of the pelvic ring, the stability of lateral compression type 1 injuries that were managed in a Level-I Trauma Centre. The documentation of the short-term outcome of the management of these injuries was our secondary aim. METHODS: A total of 63 patients were included in the study. Thirty-five patients (group A) were treated surgically whereas 28 (group B) were managed nonoperatively...
December 2012: International Orthopaedics
Diego Sarotti, Roberto Rabozzi, Paolo Franci
OBJECTIVE: To evaluate the intraoperative efficacy of intrathecal anaesthesia with hyperbaric bupivacaine 0.5% and morphine 1% solution (HIA) in dogs undergoing hind limb orthopaedic surgery, using the cardiovascular response to surgical stimulation and to report the perioperative side effects. STUDY DESIGN: Retrospective clinical study. ANIMALS: Forty-three dogs that underwent general anaesthesia for hind limb orthopaedic surgery between 2010 and 2011...
March 2013: Veterinary Anaesthesia and Analgesia
Matthew T V Chan, Alex C M Wan, Tony Gin, Kate Leslie, Paul S Myles
Nitrous oxide is an antagonist at the N-methyl-D-aspartate receptor and may prevent the development of chronic postsurgical pain. We conducted a follow-up study in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA) trial patients to evaluate the preventive analgesic efficacy of nitrous oxide after major surgery. The ENIGMA trial was a randomized controlled trial of nitrous oxide-based or nitrous oxide-free general anesthesia in patients presenting for noncardiac surgery lasting more than 2 hours...
November 2011: Pain
F-L Chang, S-T Ho, M J Sheen
Nausea and vomiting are frequent complications of intrathecal morphine. In this randomised, double-blind trial, we tested the efficacy of mirtazapine, an antidepressant that blocks receptors associated with vomiting, on the incidence of nausea and vomiting after intrathecal morphine. One hundred patients receiving spinal anaesthesia for lower limb surgery were assigned equally to take either an orally disintegrating form of 30 mg mirtazapine or matching placebo 1 h before surgery. Spinal anaesthesia was performed by injection of 15 mg isobaric bupivacaine 0...
December 2010: Anaesthesia
Shona Charlton, Allan M Cyna, Philippa Middleton, James D Griffiths
BACKGROUND: The transversus abdominis plane (TAP) block is a peripheral nerve block which anaesthetises the abdominal wall. The increasing use of TAP block, as a form of pain relief after abdominal surgery warrants evaluation of its effectiveness as an adjunctive technique to routine care and, when compared with other analgesic techniques. OBJECTIVES: To assess effects of TAP blocks (and variants) on postoperative analgesia requirements after abdominal surgery. SEARCH STRATEGY: We searched specialised registers of Cochrane Anaesthesia and Cochrane Pain, Palliative and Supportive Care Review Groups, CENTRAL, MEDLINE, EMBASE and CINAHL to June 2010...
December 8, 2010: Cochrane Database of Systematic Reviews
Raquel Peláez, Gabriel Pascual, José L Aguilar, Peter G Atanassoff
In patients with aggressive tumors resistant to conventional pain treatment, regional anaesthesia frequently becomes an alternative therapy. Cervical paravertebral nerve block among several access options to the brachial plexus is barely ever used. We present a case with severe shoulder and upper extremity pain owing to an expanding Pancoast tumor exhibiting compression upon the brachial plexus. Continuous intrathecal morphine infusion and adjuvant treatment was not sufficient to render the patient pain-free...
December 2010: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
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