Lauretta Maria P, Marino Luca, Bilotta Federico
Department of Medicine and Surgery Sciences, Anaesthesiology and Pain Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Mapighi of Bologna, Bologna.
Departments of Mechanical and Aerospace Engineering.
Clin J Pain. 2025 Feb 1;41(2):e1261. doi: 10.1097/AJP.0000000000001261.
The rationale of adoption opioid-sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioids combined with nonopioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA), and the present scoping review (ScR) aims at providing clinical evidence of the safety and efficacy of OSA with respect to OA.
This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed and EMBASE databases were utilized to find relevant studies. The search strategy included the following keywords: "opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety." The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed.
In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy end points include hemodynamic stability and anesthetic/analgesic requirements. Postoperative end points include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, and chronic postsurgical pain. The studies reported lower intraoperative mean arterial pressure and heart rate fluctuations when α 2 agonists were adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α 2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrochloride, and locoregional anesthesia techniques with a positive impact on most of the end points considered.
The clinical implementation of OSA encompasses the perioperative use of nonopioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient safety.
采用阿片类药物节省麻醉（OSA）的基本原理是在手术期间及术后使用最少的阿片类药物并联合非阿片类辅助药物来实现围手术期镇痛，即多模式麻醉。OSA方法最初是为克服基于阿片类药物的麻醉（OA）的已知并发症而开发的，本范围综述（ScR）旨在提供OSA相对于OA的安全性和有效性的临床证据。
本ScR主要关注提供OSA与OA安全性和有效性证据的研究。利用PubMed和EMBASE数据库查找相关研究。检索策略包括以下关键词：“阿片类药物节省麻醉并发症、阿片类药物节省麻醉疗效、阿片类药物节省麻醉安全性”。纳入的25项研究的结果分为以下子部分：文章特征、研究目的、OSA方案以及分析的手术环境。
在25项综述研究中，考虑了与OSA相对于OA的影响相关的证据。术中安全性和有效性终点包括血流动力学稳定性和麻醉/镇痛需求。术后终点包括早期认知功能障碍、阿片类药物引起的肠道紊乱情况、分娩和急诊剖宫产后母亲和新生儿的身体状况、全身免疫和炎症改变、术后恢复情况、住院期间和长期阿片类药物需求、术后早期疼痛以及慢性术后疼痛。研究报告称，采用α2激动剂时术中平均动脉压和心率波动较低，而其他并发症发生率无差异。对术后情况的OSA方法分析包括α2激动剂、NMDA受体阻断剂、加巴喷丁类药物、盐酸奈福泮以及区域麻醉技术，这些对所考虑的大多数终点都有积极影响。
OSA的临床实施包括围手术期使用非阿片类药物和区域麻醉技术。综述研究报告称OSA是一种可行的方法，可减少与阿片类药物相关的并发症，且对患者安全无影响。
