Opioid Free Total Intravenous Anesthesia within an Enhanced Recovery after Surgery Pathway for Bariatric Surgery: A Randomized Controlled Clinical Trial
Jonathan Farshadmand, 1Donald
1 BS ,
Louis Ballas,
• Opioids are routinely used intraoperatively and to manage • Opioids are associated with several side effects including delayed awakening, respiratory depression, and postoperative nausea and (PONV) 3
• The high incidence of obstructive sleep apnea and PONV in bariatric surgery patients make them particularly vulnerable to these side effects, placing them at increased risk for postoperative
Group 1 Averages 115 Group 2 Averages 89.25
98.3
132.7
8
17.3
32
31.3
28
127
148*
5.3
202.3
22
23.3
2.3
• Patients in both groups showed an increase of quality of recovery 2weeks post-operatively compared to baseline. • The intraoperative protocol used in Group 2 resulted in a sustained benefit over Group 1 in terms of QoR-15 scores. • Preliminary results indicate that patients in Group 2 had fewer postoperative side effects than Group 1.
140
view.5
Hypothesis
Future Direction
120
QOR-15 Scores
• Few studies have utilized the QOR-15 to assess recovery from the
100
80
Primary Objective
Secondary Objectives
Group 1
60
Patients signed informed consent prior to surgery. Eligible patients were randomly assigned into either ARM 1-OFA group or ARM 2-OA group. Both groups received standard ERAS care. QOR-15 scores were assessed at baseline, 24 hours postoperatively, and at two-weeks. Patients’ nausea, pain, and incidence of vomiting were assessed within the first 24 hours.
•
Examine the potential for drug error when preparing and utilizing multiple infusions.
•
0
24hr Post-Op QOR
2 week Post-Op QOR
Time QOR-15 was Performed
Methods
Analyze the cost and safety profile of OFA versus OA
40
Pre-Op QOR
Compare postoperative pain Compare QOR-15 scores of OFA to scores, opioid use, time to first standard opioid anesthesia (OA) rescue medication, PONV, and during bariatric surgery hospital length of stay
• Group 2
20
4.
inconclusive, and our study is ongoing.
160
physiological endpoints, morbidity, and mortality.
3.
• Given the small sample of data collected thus far, our analysis is
Opioid vs Opioid-Free Anesthesia QOR Scores
• Most studies evaluating recovery after surgery focus on
2 MD
Conclusions
Table 1. Pre- and post-operative data for patients in Group 1 and 2. QoR-15 scores, total morphine equivalent dose(MED), time until first opioid use, total pain scores at rest and motion, and total nausea scores. * Data obtained was from single patient not an average score.
complications6
1. 2.
Judith Aronsohn,
University Hospital at Northwell
Post- op Pain 24hr 2-week Pain Sum of Scores Pre-Op Total opioid Post-Op Post-Op Scores Nausea QOR MED rescue on QOR QOR at rest Score (min) motion
surgeries were performed in the US in 20191 postoperative pain3
2 Northshore
2 MS ,
Results
• Due to the ongoing obesity epidemic, over 256,000 bariatric
patient’s point of
Andrea Ruggiero,
and Barbara Zucker School of Medicine at Hofstra/Northwell,
Background
vomiting
2 BS ,
Figure 1. QoR-15 scores pre- and post-operatively. Higher scores indicate better quality of recovery. Patients' quality of recovery improved over time. Patients in Group 2 had significantly higher scores 24 hours post-operatively than patients in Group 1. P-value Pre-Op QOR
0.473
24hr Post-Op QOR
0.057
2-week Post-Op QOR
*
Total MED
0.523
Figure 7: Independent CRISPR rescue knockout of CDK4 or CDK6 Pos-op opioid (min) does not cause dropout in most breast cancer cell lines studied.
0.328
Pain Scores at rest
0.447
Pain Scores on motion
0.549
Sum of Nausea Score
<0.001
Table 2. Differences between groups for primary and secondary outcomes. *Data were not obtained at the time of data analysis.
Explore the impact of OFA on first case start and turnover time in high volume institutions
Resources 1. Estimate of Bariatric Surgery Numbers, 2011–2019. (2021, March 8). American Society for Metabolic and Bariatric Surgery. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers 2. Frauenknecht, J., Kirkham, K. R., Jacot-Guillarmod, A., & Albrecht, E. (2019). Analgesic impact of intra-operative opioids vs. opioid-free anesthesia: a systematic review and meta-analysis. Anesthesia, 74(5), 651–662. https://doi.org/10.1111/anae.14582 3. Koepke EJ, Manning EL, Miller TE, Ganesh A, Williams DGA, Manning MW. The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond). 2018 Jul 3; 7:16. doi: 10.1186/s13741-018-0097-4. 4. Mulier, J., Wouters, R., Dillemans, B., & Decock, M. (2018). A Randomized Controlled, Double-Blind Trial Evaluating the Effect of Opioid-Free Versus Opioid General Anesthesia on Postoperative Pain and Discomfort Measured by the QoR-40. Journal of Clinical Anesthesia and Pain Medicinewww.Scientonline.Org. Published. 5. Peter A. Stark, Paul S. Myles, Justin A. Burke; Development and Psychometric Evaluation of a Postoperative Quality of Recovery Score: The QoR-15. Anesthesiology 2013; 118:1332–1340 doi: https://doi.org/10.1097/ALN.0b013e318289b84b 6. Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, Skrivanek G, Macaluso A, Shah M, Provost DA. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg. 2008 Jun; 106(6):1741-8.