Article Recommended by Dr. Don Stader: Opioid-free Versus Opioid-sparing Anaesthesia in Ambulatory Total Hip Arthroplasty: A Randomised Controlled Trial

A recent RCT published in the British Journal of Anaesthesiology sought to compare the efficacy of opioid-sparing anesthesia (OSA) to opioid-free anesthesia (OFA) in the perioperative period and their impact on post-operative pain scores (via 11-point verbal rating scale, VSR)  and median oral morphine equivalents (OME) 24 hours post op in patients receiving total hip arthroplasty (THA). 40 patients in the OSA group were administered sufentanil on induction of anesthesia, while the OFA group received dexmedetomidine infusion. Patients were discharged from the hospital once reaching a VSR of 3 or less and meeting other discharge criteria (vitals, mobility, etc.). In the immediate post-op period, patients received IV oxycodone 2 mg every 3 min  if their pain was higher than a 3. They otherwise received multimodal postoperative pain regimen (1g acetaminophen every 6 hours, 400 mg ibuprofen every 6 hours, oral oxycodone 10 mg orally every 6 h if VRS >3/10. Pain scores and OME received were assessed by nurses, physical therapists and research assistants blinded to which group the patients were in. 

Researchers report that pain scores every 6 hours in the post-op period were nearly the same in each group. They also note that the difference in median OME consumed in 24 hours is not different amongst the groups, though the result is not statistically significant (P=0.6) due to the study being underpowered. They note that OME’s consumed in both groups post-op were lower than expected and that side effects (including nausea/vomiting often associated with opioids) were similar between groups.

Key Takeaways:

• This study suggests that post-op pain scores in THA are not significantly different in patients receiving OSA or OFA, but a larger cohort is needed to investigate if there is an impact on OME consumption in the post-op period.
• It is difficult to compare the impact of analgesia management protocols for different patient cohorts and types of surgeries; however, the current body of literature suggests we definitely do not need as many opioids as previously used and that multimodal analgesia is effective at treating pain and reducing unnecessary opioid prescriptions. 

https://www.sciencedirect.com/science/article/abs/pii/S000709122300586X?casa_token=cRQ1ipoPgyEAAAAA:8m3v2El0cxWhjnrWiNQqlW9Eg21PxRH4my8ZBVAGFrsOJiGYzhzNjPpSZtFs5AUhXRtnwAubVQ