C. Bosquet1, Z. Khene1, T. Daouphars1, K. Bensalah1, J. P. Estebe1
1University hospital of Rennes - Rennes (France)
Background:
Robotic partial nephrectomy (RPN) has traditionally been performed under regular general anesthesia (RGA) with opioid analgesics. However, opioids are associated with adverse drug events (including nausea, vomiting, constipation, postoperative sedation), which lead to an increased length of stay.
Objectives: To compare recovery outcomes between opioid free anesthesia (OFA) and RGA.
Materials and methods:
We retrospectively analyzed, the files of 93 patients who underwent au RPN for cancer, between January 2016 and November 2017. We stratified the cohort into groups according to the type of anesthesia. 26 patients received OFA protocol (Dexmedetomidine, Lidocaine, Ketamine and Dexamethasone), and 67 patients received RGA protocol (Sufentanil or Remifentanil, dexamethasone, ketamine and lidocaïne
according to anesthesiologist choice). Postoperative analgesia was multimodal (NSAID, nefopam, acetaminophen, lidocaïne, tramadol). Morphine was used as rescue analgesia, by oral route in floor or intravenous (IV) route in PACU.
We compared occurrence of PONV and use of anti emetics, maximal numeric pain scale (MNPS) and opioid consumption in the first 48 hours, and length of stay in the two groups. Linear and logistic regression analyses were performed with JMB Statistical Discovery Software, results were expressed in mean ± SD.
Results and discussion:
There were slightly more men in both groups (OFA group 54% and 61% in RGA, respectively), mean age of 56(±14) years in OFA group and 58(±13) years in RGA group.
OFA was significantly associated with less PONV 12% vs 37% (p = 0,02), and a significant reduction of LOS was observed 3,1±2,6 days vs 4,4±2,6 days (p<0,0001). The trend of reduction of postoperative morphine consumption (expressed in equivalent IV morphine: 1,5±2,7 mg vs 4,5±7,7 mg (p=0,09) and 0,4±1,1 mg vs 1,5±3,2 mg (p=0,11) at D1 and D2) and MNPS reduction (4,3±2 mm vs 4,5±2,2 mm (p=0,69); 2,4±2,2 mm vs 3,3±2,2 mm (p= 0,05) at D1 and D2) does not reach the significance.
Conclusion:
This retrospective study confirms our hypothesis. Despite the lack of significance, the trend of decrease of pain and opioid requirements observed in the OFA group allow to observe a significant reduction of PONV and LOS. These results must be confirmed by a prospective evaluation.

07 / Robotic partial nephrectomy under opioid free general anesthesia (OFA): A comparative study