Special indications for OFA, patient and procedure related

Publication date: Available online 16 November 2017 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Roman Schumann, Adrian Sultana, David Torres Opioid Free Anesthesia is a technique where no intra-operative systemic, neuraxial, or intra-cavitary opioid is administered during the anesthetic. Opioid Free Analgesia similarly avoids opioids in the perioperative period. There are many compelling reasons to avoid opioids in the surgical population. A number of case reports and increasingly, prospective studies from all over the world support its benefits especially in the morbidly obese population with or without sleep apnoea. A derivative technique is opioid sparing where the same techniques are used but some opioid use is allowed. This chapter is a review of the current knowledge regarding opioid free or low dose opioid anesthetic and analgesic techniques for the following special populations: Obesity, Sleep Apnoea, Chronic Obstructive Pulmonary Disease, Complex Regional Pain Syndromes, Acute/Chronic Opioid Addiction and Cancer Surgery. Practical aspects include Sympatholysis, analgesia, and MAC reduction with dexmedetomidine, analgesia with low-dose ketamine and co-anaesthesia plus sympatholysis with intravenous lignocaine. Non-opioid adjuvants such as NSAIDS, Paracetamol, Magnesium, local anaesthetic infiltration and high dose steroids are added in the perioperative period to further achieve co-analgesia. Loco-regional Anaesthesia and analgesia...
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research