Opiate-free anaesthesia linked to fewer painkillers later
Patients undergoing breast cancer surgery need less painkilling medication post-surgery if they have anaesthesia that is opiate-free, according to a Belgian study.
Researchers highlighted that, while opioid drugs provide an excellent painkilling effect throughout operations, they also have side-effects.
Post-operative complications, such as respiratory depression, post-operative nausea and vomiting, itching, difficulty going to the toilet and bowel obstruction are well known examples, they noted.
In their study, painkiller requirements were examined after 64 patients received opiate anaesthesia and non-opiate anaesthesia. The study, which involved two groups of breast cancer patients undergoing a mastectomy or lumpectomy, took place between September 2014 and July 2015.
Perioperative non-opiate analgesia was obtained by combining clonidine (0.2mcg/kg), ketamine (0.3mg/kg) and lidocaine (1.5mg/kg). An extra bolus of ketamine (0.2mg/kg) was given if necessary.
Opiate analgesia was obtained via a combination of remifentanil infusion, ketamine (0.3mg/kg) and lidocaine (1.5mg/kg).
Both groups received intravenous paracetamol (1,000mg/6h) and intravenous diclofenac (75mg/12h). Patients received a patient-controlled analgesia pump for breakthrough pain during the first 24 hours post-operatively.
The researchers found total mean piritramide usage 24 hours post-operatively was 8.1mg in the non-opiate group and 13.1mg in the opioid group.
Study author Dr Sarah Saxena, Jules Bordet Institute in Brussels, said: “Our results show that patients in the non-opiate group require less painkillers, but receive adequate pain relief. Patients require less analgesics 24 hours after a non-opiate anaesthesia than after an opiate anaesthesia.”
She added: “This study shows a possible interesting benefit of this type of approach, which needs to be confirmed in further studies.
“Non-opiate anaesthesia in breast cancer surgery might avoid several opiate-related side effects such as post-operative nausea and vomiting. It might also reduce cancer recurrence,” said Dr Saxena.
“However, it is too early to recommend non-opiate anaesthesia to all breast cancer patients,” she said. “We will be doing further research to confirm and extend our findings.”
The research was presented at the Euroanaesthesia 2016 meeting in London.
Source: Nursing Times