Opioid-free anesthesia. Review of the technique and application in a case of a patient addicted to opiates.

Abstract

INTRODUCTION: Opioids are the classic basis of intraoperative analgesia, but they have known undesirable effects: nausea, vomiting, sedation, ileus, respiratory depression, hyperalgesia, tolerance, chronic postoperative pain, addiction... Opioid-free anesthesia is based on using Ketamine. , Dexmedetomidine, Lidocaine and other adjuvant drugs such as NSAIDs, corticosteroids, magnesium, hypotensives, together with regional blocks managed with local anesthetics, to achieve multimodal anesthesia that replaces opioids as much as possible.

METHOD: We present a case of a patient chronically addicted to opiates, who underwent a laparotomy for abdominoperineal amputation. Initially, a lumbar epidural catheter was placed through which bolus 0.25% levobupivacaine was administered during the intraoperative period. In addition, the patient was successfully managed with the protocol that we describe in the article, using a mixture of drugs as preemptive analgesia, before the surgical incision, in order to prevent CNS sensitization to pain; It consists of NSAIDs, Dexamethasone and magnesium sulfate. Subsequently, during anesthetic induction and maintenance, a mixture of Lidocaine, Dexmedetomidine and Ketamine is administered at low doses, together with the usual doses of Propofol and relaxation with Rocuronium.

RESULT: OFA allowed adequate anesthetic management, with optimal hemodynamic stability and no notable side effects.

CONCLUSION: OFA is a very adequate alternative in the anesthetic management of patients addicted to opioids, achieving excellent results. Extensive familiarization of the anesthesiologist with the pharmacology of the various formulas used is required, as well as their protocolization.

KEYWORDS: opioid-free anesthesia, OFA, analgesia, surgery, adverse effect, pain, opioid disorder.