Opioid Free Anesthesia - Advantages and Contraindication

Creator: Dr. Swati Sharma
Published: 2023-04-26T18:08:45

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Opioid-free anesthesia is used instead of opioids to overcome the addiction to opioids. This topic presents opioid-free anesthesia and its advantages.

Written by

Dr. Swati Sharma

Medically reviewed by

Dr. Sukhdev Garg

April 26, 2023

January 11, 2024

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Contents

What Are Opioids?
Why Do Opioids Need to Be Stopped?
What Are the Side Effects of Opioids?
What Are the Alternatives to Opioids?
What Are the Advantages of Opioid-Free Anesthetics?
What Are the Contraindications of Opioid-Free Anesthesia?

Introduction

Opioids are the most commonly used pain-relieving medicine. They do relieve the pain but cause addiction for a long time. Opioid addiction has caused the death rate to increase, especially in the United States. Opioid overdoses have compelled doctors to stop their use. Steps like primary prevention to prevent opioid addiction during the operating period. Substituting opioids with other analgesic medicine during the operative period is the most effective way to stop opioid use.

What Are Opioids?

Opioids are drugs that work on the brain to produce various effects, including pain relief. Opioids, including pain-relieving, have the additional property of making some people feel happy or relaxed. A type of euphoria (a state of excitement and happiness) effect is formed. They affect the nervous system of the body. Opioids can be prescribed medicine by a doctor or any street drug like Heroin. They are sometimes also referred to as narcotics. The most commonly used opioids are prescribed drugs Oxycodone, a synthetic opioid, Fentanyl, and an illegal drug Heroin.

Why Do Opioids Need to Be Stopped?

All opioids can lead to addiction. Regular use of opioids can increase its dependence and tolerance, leading to more body demand for use. And unknowingly further leading to addiction. Opioid dependence can cause withdrawal symptoms, which makes it difficult to stop taking them. Moreover, it can cause difficulty in breathing and the risk of respiratory depression can occur. Taking more and more opioids has resulted in death.

What Are the Side Effects of Opioids?

Side effects of opioids are:

Drowsiness.
Nausea and vomiting.
Constipation.
Respiratory Depression - Respiratory depression is the most significant opioid side effect. It is mostly seen in obesity, sleep apnea, and pulmonary diseases.
Impaired gastrointestinal function by delaying gastric emptiness.
Increasing sensitivity to feel the pain.
Dry mouth.
Muscle rigidity.
Arrhythmia (irregular beating of the heart).
Weakening immune system.
Pruritus (itchy skin).
Delirium (disturbed state of mind with confusion and illusion).
Urinary tract infections due to urinary retention.

What Are the Alternatives to Opioids?

Alternatives to opioids are necessary. The ill effects of opioids have made doctors shift to opioid-free drug use in anesthesia. The alternatives to opioids are:

Dexmedetomidine - Dexmedetomidine is an alpha-2 agonist with analgesic action. It is an ideal agent for opioid-free anesthesia. It has better results than opioids. It has bronchodilator (to dilate lungs) properties and the absence of common side effects of opioids like respiratory depression, urinary retention, nausea, and vomiting. It has decreased opioid requirements by 50 percent.
Intravenous Acetaminophen - It is a non-opioid pain-relieving drug with low anti-inflammatory properties. Its intravenous (injecting into veins) mode of administration has a more potent effect with faster onset. It could be risky for liver disease patients. And its dose should be less than 15 milligrams per kilogram.
Lignocaine - Lignocaine is a pain-relieving drug. It is a local anesthetic drug. It also does not show any opioid effects. But over-usage of lidocaine can show side effects like the metallic taste, tinnitus (ringing noise in the ears), and seizures. It works as an anesthetic and anti-inflammatory medicine. Its recovery is better than opioids.
Ketamine - It decreases opioid requirements and postoperative pain. Ketamine is used in patients with high opioid requirements.
Intravenous Ketorolac - Ketorolac is a non-steroidal anti-inflammatory drug with pain relieving (analgesia) properties. Cautious use of it should be done with renal impairment patients and asthmatics.
Gabapentin/Pregabalin - Gabapentinoids are derivatives of gamma aminobutyric acid (GABA). They are analgesics that can work on neuropathic pain. They are useful in postoperative periods. Excessive usage can also cause dizziness, sedation, and visual disturbances.
Magnesium - It has an analgesic action by working on calcium influx into cells. It also can relieve neuropathic pain. It is also used in postoperative pain relief. While using magnesium, one should lower the doses of muscle relaxants and anesthesia drugs. It has side effects of hypotension (low blood pressure) and bradycardia (slow heart rate).
Regional Anesthesia - It includes peripheral nerve blocks. Postoperative pain management is performed through peripheral nerve block or infiltrating with the local anesthetic instead of opioids.
A Mixed Agonist-Antagonist - It acts on opioid receptors like Dezocine and Buprenorphine. They are less addictive. And they show fewer side effects than opioids. They are used in treatments of opioid addiction.

What Are the Advantages of Opioid-Free Anesthetics?

Opioid-free anesthesia has benefitted many patients. However, they have some specific advantages. The advantages of opioid-free anesthetics are:

Obesity and Obstructive Sleep Apnea: Patients with obesity and obstructive sleep apnea syndrome are usually at risk of developing respiratory depression and other side effects of opioids. But opioid-free drugs have decreased the risk factors of obesity and obstructive sleep apnea syndrome. Dexmedetomidine has proven safe and effective in keeping these patients' sleep and airway normal.
Cancer Surgery: Opioid use has resulted in the recurrence of cancers. Along with this, opioids have decreased the immunity levels of the patients and led to the proliferation of tumors. With opioid avoidance, beneficial results have been seen in surgical procedures like breast cancer and colorectal cancer surgery.
Fast Postoperative Recovery: Opioid avoidance has made it possible to prevent any post-side effects of opioids, decreasing long hospital stays. The patient's recovery is better and faster than with opioids uses drugs.

What Are the Contraindications of Opioid-Free Anesthesia?

The contraindications of opioid-free drugs are:

Alpha-2 agonists are to be used cautiously in patients with cardiovascular diseases and elderly patients.
Ketorolac should be cautiously used in renal impairment and asthmatic patients.
Acute coronary syndrome (sudden blockage of blood to the heart).
Hypovolemic shock (a condition in which the heart cannot pump blood to the body).
Autonomic dysfunction (when the autonomic nervous system is unable to work properly).

Conclusion

The opioid-free anesthesia is in use nowadays. Opioid has many side effects, and their addiction is even worse. Opioid avoidance has benefitted patients. The drugs used as an alternative to opioids are Dexmedetomidine, Lignocaine, Ketamine, Ketorolac, Magnesium, and Gabapentin. Regional anesthesia can also be used as postoperative analgesia. The advantage of opioid-free opioid drugs is that respiratory depression is overcome. The opioid-free anesthetics do not cause respiratory depression, and recovery of the patients is better through opioid-free.

Frequently Asked Questions

1. What Precautions Should Be Observed When Administering Non-opioid Analgesics?

When administering non-opioid analgesics, meticulous consideration of patient history, potential drug interactions, and individual health conditions is imperative to ensure optimal pain management with minimal risks. Monitoring for adverse effects, such as gastrointestinal issues with NSAIDs (non-steroidal anti-inflammatory drugs), adds an extra layer of precaution.

2. How Do Opioids Contribute to the Field of Anesthesia?

Opioids contribute to anesthesia by inducing analgesia and sedation, playing a pivotal role in ensuring patient comfort during surgical procedures. Their ability to modulate pain perception in the central nervous system makes them indispensable in achieving adequate pain control during various medical interventions.

3. What Factors Increase the Likelihood of Opioid Use Following Surgery?

Factors such as a history of chronic pain, previous opioid dependence, and psychological considerations can increase the likelihood of opioid use following surgery, necessitating personalized pain management plans. Enhanced preoperative screening and education can help identify and address these factors proactively.

4. How Does Opioid-Free Analgesia Differ From Opioid-Based Approaches?

Opioid-free analgesia emphasizes employing alternative methods, reducing reliance on opioids to mitigate potential side effects and the risk of dependence, offering a tailored approach to pain relief. Utilizing regional anesthesia techniques, such as nerve blocks, is a common strategy in opioid-free protocols.

5. What Alternatives Exist for Potent Pain Relief Without Opioids?

Non-opioid alternatives for potent pain relief include NSAIDs and acetaminophen, providing effective options without the inherent risks associated with opioids. Integrating multimodal analgesia, combining different non-opioid agents, is increasingly recognized for optimizing pain control and minimizing side effects.

6. What Is the Primary Purpose of Non-opioid Medications?

The primary purpose of non-opioid medications is to offer pain relief without the addictive properties of opioids, addressing discomfort through different mechanisms of action. These medications are pivotal in managing mild to moderate pain and are often preferred for certain patient populations, such as those at risk for opioid-related complications.

7. How Can Non-opioid Analgesics Be Classified?

Non-opioid analgesics can be classified into categories such as NSAIDs, acetaminophen, and adjuvant medications, each with distinct modes of action and applications. Tailoring the choice of non-opioid analgesic based on the patient's condition and potential contraindications is fundamental in optimizing pain management.

8. Which Non-opioid Medication Is the Most Widely Used?

Acetaminophen, also known as paracetamol, stands out as one of the most widely used non-opioid medications for pain and fever management. Its safety profile and effectiveness make it a preferred choice, particularly in situations where NSAIDs may be contraindicated.

9. Can You Provide Examples of Two Opioid Analgesics?

Examples of opioid analgesics include morphine and oxycodone, both potent medications used for managing moderate to severe pain. However, their use is tempered by the risk of side effects, including respiratory depression and the potential for addiction.

10. What Is Another Term for Non-opioid Analgesics?

Another term for non-opioid analgesics is "opioid-sparing" medications, highlighting their role in reducing the need for opioids in pain management strategies. This approach aligns with the goal of minimizing opioid exposure while still achieving adequate pain control.

11. What Mechanisms of Action Are Associated With Non-opioids?

Non-opioid analgesics exert their effects through various mechanisms. NSAIDs (nonsteroidal anti-inflammatory drugs) inhibit prostaglandin synthesis, reducing inflammation and pain. Acetaminophen's exact mechanism isn't fully understood but involves central nervous system modulation. Adjuvant medications may target different pathways, enhancing overall pain relief through a multimodal approach.

12. To What Extent Are Opioids Considered Important in Medical Contexts?

Opioids are crucial in medical contexts for their potent analgesic properties. Their ability to bind to opioid receptors in the central nervous system modulates pain perception, making them essential in managing moderate to severe pain, especially after surgery or trauma. However, their use requires careful consideration due to potential side effects and the risk of dependence.

13. What Are the Latest Opioids Introduced in Anesthesia Practices?

The latest opioids introduced in anesthesia practices often include newer formulations and delivery methods to enhance safety and efficacy. Examples include extended-release formulations or novel opioid agonist-antagonist combinations designed to minimize side effects and reduce the risk of misuse.

14. In Day Care Surgery, Which Opioid Is Commonly Utilized?

In day care surgery, the opioid commonly utilized is often short-acting and has a rapid onset and offset to facilitate recovery and minimize the risk of postoperative complications. Fentanyl is a frequently chosen opioid in this context due to its quick onset and short duration of action.

15. What Physiological Actions Are Characteristic of Opioids?

Physiological actions characteristic of opioids include pain relief through modulation of neurotransmitter release, primarily by binding to mu-opioid receptors. Additionally, opioids can cause respiratory depression, sedation, and euphoria, contributing to their analgesic effects but necessitating careful monitoring for potential side effects.

Sources

Dr. Sukhdev Garg

Anesthesiology

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