Opioid free anaesthesia/analgesia in patients undergoing thoracic surgery: a case series

Background and aims
Poor control of postoperative pain in thoracic surgery contributes to perioperative morbidity and mortality. Although there are guidelines for perioperative pain management in these patients, there is no widespread anaesthetic "best practice.
Methods
This is a case series of patients undergoing thoracic surgery under general anesthesia using an Opioid-free anaesthesia (OFA) technique. Premedication included midazolam (0.05mg/Kg IM) in the ward. Induction of anesthesia was achieved with ketamine, propofol, magnesium sulphate, lidocaine and rocuronium. Acetaminophen was administered prior to surgical incision while maintenance of anesthesia included volatiles, dexmedetomidine and lidocaine infusion and ketamine (infusion or repeated bolus) (table 2). Acetaminophen, parecoxibe and tramadol were prescribed for post-operative pain management, while opioids were used as rescue therapy.
Results
17 patients included in the study. Demographic data are shown in the table 1 and postoperative assessment in table 3.  

Table 1. Patient Characteristics 
Age (years)* 	6412
BMI (Kg/m2)*  	27.16  2.21
ASA class II**	15(88%)
Gender Male** 	12(70.5%)

Table 2. Intraoperative drug use 	
Ketamine (mg)* 	165.385.89
Magnesium sulphate (mg)* 	5.6252.14
Dexmedetomidine (μcg)* 	279.18119.23
Lidocaine infusion (mg)* 	263.977.6
Dexamethasone (16mg)** 	16(94.1%)

Table 3. Postoperative assessment in PACU and at 24 h postoperatively
	PACU	24 h  
VAS at rest*** 	0(0-0)	0(0-0)
VAS on cough*** 	2.5(0.5-5)	2(0-3)
VAS on movement*** 	2(1-4)	2(0.75-3)
Delirium** 	1(6%)	0
Nausea /vomiting**	0	1(6%)
Mobilization** 	-	14(82%)
Rescue opioid analgesia**	4(23.5%)	1(6%)

*mean  SD, ** n(%), *** median(IQR)
Conclusions
OFA can be a safe and effective approach for the perioperative management of patients undergoing thoracotomy

OPIOID FREE ANAESTHESIA/ANALGESIA IN THORACIC SURGERY: A CASE SERIES