People with Ehlers-Danlos syndrome (EDS) who undergo surgery to fix joint problems experience less pain when given opioid-free anesthesia and post-surgery pain management, a study reports.
The study, “Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach,” was published in the Orphanet Journal of Rare Diseases.
A common feature of EDS is joint hypermobility — also called joint hypermobility syndrome — a condition defined by larger-than-normal range of motion in one or more joints. In EDS patients, this can affect the ligaments that connect the skull to the spine, leading to a condition called cranio-cervical instability.
Instability in the cervical spine can lead patients to experience alterations to vision, hearing, and speech as well as swallowing, among other symptoms. EDS patients with cranio-cervical instability often have widespread pain, which is hard to manage and often not controlled by opioids, a type of medicine used for pain relief but has serious side effects, including addiction.
Cranio‐cervical fixation is a surgical procedure used to realign and immobilize the connection between the head and neck. To improve patient recovery after surgery, new protocols have been developed that include opioid-free anesthetics (OFA).
In the study, researchers in Spain conducted a case-series investigation (NCT04437589) to assess whether OFA together with powerful analgesics (OFA-plus) lessened postoperative pain and helped reduce the need for opioids compared with opioid-based anesthesia (OP) in EDS patients who underwent cranio-cervical fixation surgery from September 2018 to March 2020.
In total, 42 EDS patients with joint hypermobility syndrome were enrolled in the study (39 women and three men). The OFA-plus group included 19 patients and the OP group had 23. All patients were of similar body composition (according to their body mass index, a measure of body fat) and showed no differences in their pain levels before surgery, as assessed using a visual analogue score (VAS).
In the OFA-plus intervention group, patients received intravenous (directly into the blood) opioid-free anesthesia composed of a combination of lidocaine (local anesthetic), ketamine (general anesthesia), and dexmedetomidine (sedative), together with propofol (a sedative-hypnotic agent to help relax the patient before general anesthesia). Those in the OP group received a opioid-based anesthesia (a combination of fentanil, remifentanil, or sufentanil) with propofol.
Postoperative management remained opioid-free in the OFA-plus group, while morphine infusions were administered in the OP group. In both groups, methadone was administered whenever severe pain occurred.
After surgery, VAS scores showed a significant reduction from day one to day six in patients in the OFA-plus group compared to the OP group. This reduction in pain scores was more evident immediately after surgery (day one), with a 32% reduction in the OFA-plus group.
The length of hospital stay was similar between groups — mean average of 19 days in the OFA-plus vs. 22 days in the OP group.
While 95% of those in the OP group required methadone, an opioid used for pain crises, such treatment was required by 22% of those in the OFA-plus group. Moreover, in the OP group, 42% of patients required high doses of methadone (over 15 mg/day) to manage postoperative pain.
The team also reported that in the first day after surgery, the need for another opioid analgesic, sufentanil, was significantly reduced in patients in the OFA-plus group compared with the OP group.
Patients in the OFA-plus group experienced less nausea, vomiting, and ileus (lack of movement in the intestines). No difference in constipation incidence was seen between groups.
The OFA-plus group also showed a 77% reduction in anxiolytic (anti-anxiety medicine) use. In contrast, 63% of patients in the OP group required frequent administration of anxiolytics (over three times a day).
Also, over 60% of the OFA-plus patients decreased their need for opioids after discharge from the hospital, while no changes were observed in patients in the OP group. Four patients (17.4%) in the OFA-plus group experienced visual hallucinations.
Overall, the results showed that “OFA‐plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation,” the researchers wrote.
Opioid‐free anesthesia is therefore a “feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side‐effects” in EDS patients who undergo craneo‐cervical fixation surgery, they concluded.
Opioid‐free Anesthesia Found to Improve Pain Control After Surgery - Ehlers Danlos News
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