Opioid-free blended analgesia in patients undergoing thoracic surgery: Preliminary results.

OBJECTIVE: Thoracic surgery is recognized as one of the most painful surgical procedures. Opioids represent the most effective analgesic drug for pain management after these procedures. However, opioid use is related to side effects such as nausea, constipation, drowsiness, hypotension, bradycardia. Because of this, recently, studies have focused on blended analgesia, which combines general and loco-regional anesthesia (LRA).This study aims to demonstrate the effectiveness of opioid-free blended anesthesia in pain management in patients undergoing open or endoscopic thoracic surgery. DESIGN: Prospective study. SETTING: Tertiary public hospital. PATIENTS: Fifty-four patients undergoing thoracic surgery were enrolled according to criteria: both sexes; aged over 18 years; underwent open or thoracoscopic thoracic surgery; underwent thoracic paravertebral block (TPVB) and/or erector spinae plane block (ESPB), American Society of Anesthesiologist (ASA) between 1 and 4. INTERVENTION: Based on the type of surgery, different types of LRA were performed: TPVB in the case of thoracotomy, ESPB in the case of endoscopic surgery, combination of both techniques in the case of mini-thoracotomy. Patients received Ropivacaine-based LRA and general anesthesia with Sevoflurane, with rescue opioids administered only if necessary. MAIN OUTCOME MEASURE: Pain assessment was performed with the Numerical Rating Scale 6, 12, 36, 48 hours after surgery. RESULTS: LRA performed included two-level paravertebral blocks in 51.85 percent of cases, two-level ESPBs in 7.41 percent of patients, combination of the two techniques in 40.74 percent of cases. No side effects were recorded during the post-operative period. Vital signs were normal during hospitalization. All patients except one reported pain values of less than 3 during the measurements. CONCLUSIONS: This is the first study that demonstrated the effectiveness of opioid-free blended anesthesia after both open and endoscopic thoracic surgery. However, the expertise of the anesthetist is the key for the successful result of this procedure.