Effect of opioid-free anesthesia on post-operative period in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched study

Abstract

Background

Postoperative pain after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is important. It appears essential to reduce postoperative pain and morphine consumption.

Methods

Retrospective study in a university hospital comparing patient benefiting from CRS-HIPEC under opioid-free anesthesia (OFA; dexmedetomidine) to those anesthetized with opioid anesthesia (OA; remifentanil) using a propensity score matching method. The main objective was the impact of OFA on postoperative morphine consumption in the first 24 h after surgery.

Results

102 patients were included, matching on the propensity score allowed selecting 34 unique pairs analyzed. Morphine consumption was lower in the OFA group than in the OA group (3.0 [0.00–11.0] mg/24 h vs. 13.0 [2.5–25.0] mg/24 h; p = 0.02). In multivariable analysis, OFA was associated with a reduction of 7.2 [0.5–13.9] mg of postoperative morphine (p = 0.04). The rate of renal failure with a KDIGO-score > 1 was lower in the OFA group than in the OA group (12% vs. 38%; p = 0.01). There was no difference between groups concerning length of surgery/anesthesia, norepinephrine infusion, volume of fluid therapy, post-operative complications, rehospitalization or ICU readmission within 90 days, mortality, and postoperative rehabilitation.

Conclusion

Our results suggest that OFA for CRS-HIPEC patients appears safe and is associated with less postoperative morphine use and acute kidney injury.

Keywords:

• Cytoreductive surgery
• hyperthermic intraperitoneal chemotherapy
• opioids
• alpha 2 agonists
• opioid-free anesthesia
• analgesia
• postoperative pain
• surgery
• anesthesiology

Ethical approval

The Ethics and Evaluation Committee for Non-Interventional Research of Rouen University Hospital approved the study (n° E2020-84).

Author contributions

SL and ML were involved in the study conception and design, in acquisition of data, in analysis and interpretation of data and in manuscript draft

JS, EB, GW, JJT, JG, VC and EO were involved in in acquisition of data, analysis and interpretation of data and in manuscript revision.

BP was involved in statistical analysis, in interpretation of data and in manuscript draft

TC was involved in the study conception and design, in analysis and interpretation of data and in manuscript draft

All authors contributed to manuscript revision, read and approved the submitted version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The raw data supporting the conclusions of this manuscript can be made available on request by the authors to any qualified researcher.