Titre :

Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery.

Auteur(s) :

Beloeil, H. [Auteur]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Garot, M. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Lebuffe, Gilles [Auteur]
Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365
Gerbaud, A. [Auteur]
Bila, J. [Auteur]
Cuvillon, P. [Auteur]
Dubout, E. [Auteur]
Oger, S. [Auteur]
Nadaud, J. [Auteur]
Becret, A. [Auteur]
Coullier, N. [Auteur]
Lecoeur, S. [Auteur]
Fayon, J. [Auteur]
Godet, T. [Auteur]
Mazerolles, M. [Auteur]
Atallah, F. [Auteur]
Sigaut, S. [Auteur]
Choinier, P. M. [Auteur]
Asehnoune, K. [Auteur]
Roquilly, A. [Auteur]
Chanques, G. [Auteur]
Esvan, M. [Auteur]
Centre d'Investigation Clinique [Rennes] [CIC]
Futier, E. [Auteur]
Génétique, Reproduction et Développement [GReD]
Laviolle, B. [Auteur]
Centre d'Investigation Clinique [Rennes] [CIC]

Titre de la revue :

Anesthesiology

Nom court de la revue :

Anesthesiology

Numéro :

134

Pagination :

541-551

Date de publication :

2021-04

ISSN :

1528-1175

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background: It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there is currently no evidence to support the speculation. The authors ...
Lire la suite >Background: It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there is currently no evidence to support the speculation. The authors hypothesized that opioid-free balanced anesthetic with dexmedetomidine reduces postoperative opioid-related adverse events compared with balanced anesthetic with remifentanil.Methods: Patients were randomized to receive a standard balanced anesthetic with either intraoperative remifentanil plus morphine (remifentanil group) or dexmedetomidine (opioid-free group). All patients received intraoperative propofol, desflurane, dexamethasone, lidocaine infusion, ketamine infusion, neuromuscular blockade, and postoperative lidocaine infusion, paracetamol, nefopam, and patient-controlled morphine. The primary outcome was a composite of postoperative opioid-related adverse events (hypoxemia, ileus, or cognitive dysfunction) within the first 48 h after extubation. The main secondary outcomes were episodes of postoperative pain, opioid consumption, and postoperative nausea and vomiting.Results: The study was stopped prematurely because of five cases of severe bradycardia in the dexmedetomidine group. The primary composite outcome occurred in 122 of 156 (78%) dexmedetomidine group patients compared with 105 of 156 (67%) in the remifentanil group (relative risk, 1.16; 95% CI, 1.01 to 1.33; P = 0.031). Hypoxemia occurred 110 of 152 (72%) of dexmedetomidine group and 94 of 155 (61%) of remifentanil group patients (relative risk, 1.19; 95% CI, 1.02 to 1.40; P = 0.030). There were no differences in ileus or cognitive dysfunction. Cumulative 0 to 48 h postoperative morphine consumption (11 mg [5 to 21] versus 6 mg [0 to 17]) and postoperative nausea and vomiting (58 of 157 [37%] versus 37 of 157 [24%]; relative risk, 0.64; 95% CI, 0.45 to 0.90) were both less in the dexmedetomidine group, whereas measures of analgesia were similar in both groups. Dexmedetomidine patients had more delayed extubation and prolonged postanesthesia care unit stay.Conclusions: This trial refuted the hypothesis that balanced opioid-free anesthesia with dexmedetomidine, compared with remifentanil, would result in fewer postoperative opioid-related adverse events. Conversely, it did result in a greater incidence of serious adverse events, especially hypoxemia and bradycardia.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
CHU Lille

Collections :

• Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365

Date de dépôt :

2023-05-25T03:16:47Z
2024-05-22T09:45:52Z
2024-06-27T12:28:34Z