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      Special indications for Opioid Free Anaesthesia and Analgesia, patient and procedure related: Including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery.

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          Abstract

          Opioid-free anaesthesia (OFA) is a technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with the anaesthetic. Opioid-free analgesia similarly avoids opioids in the perioperative period. There are many compelling reasons to avoid opioids in the surgical population. A number of case reports and, increasingly, prospective studies from all over the world support its benefits, especially in the morbidly obese population with or without sleep apnoea. A derivative technique is opioid sparing, where the same techniques are used but some opioid use is allowed. This chapter is a review of the current knowledge regarding opioid-free or low-dose opioid anaesthetic and analgesic techniques for the following special populations: obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, acute/chronic opioid addiction and cancer surgery. Practical aspects include sympatholysis, analgesia and Minimum Alveolar Concentration (MAC) reduction with dexmedetomidine; analgesia with low-dose ketamine and co-anaesthesia; and sympatholysis with intravenous lignocaine. Non-opioid adjuvants such as NSAIDS, paracetamol, magnesium, local anaesthetic infiltration and high-dose steroids are added in the perioperative period to further achieve co-analgesia. Loco-regional anaesthesia and analgesia are also maximised. It remains to be seen whether OFA and early postoperative analgesia, which similarly avoids opioids, can prevent the development of hyperalgesia and persistent postoperative pain syndromes.

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          Author and article information

          Journal
          Best Pract Res Clin Anaesthesiol
          Best practice & research. Clinical anaesthesiology
          Elsevier BV
          1878-1608
          1521-6896
          Dec 2017
          : 31
          : 4
          Affiliations
          [1 ] Sydney Institute for Obesity Surgery and University of New South Wales, PO BOX 494, Double Bay, NSW, 1360, Australia. Electronic address: a.sultana@unsw.edu.au.
          [2 ] Clinica Santa Maria, Universidad de Los Andes, Outcome Research, Av. Santa Maria 0500, 6º Piso, Providencia, Santiago, 7520378, Chile. Electronic address: dtorres@clinicasantamaria.cl.
          [3 ] Tufts University School of Medicine, Tufts Medical Center, Department of Anesthesiology and Perioperative Medicine, 800 Washington St, Boston, MA, 02111, USA. Electronic address: rschumann@tuftsmedicalcenter.org.
          Article
          S1521-6896(17)30082-4
          10.1016/j.bpa.2017.11.002
          29739543
          4afbc7d3-0925-4309-a95c-a4bac633d026
          History

          chronic obstructive behaviour,techniques,sleep apnoea,pulmonary disease,postoperative analgesics,opioid hyperalgesia,opioid free,obstructive,non-narcotic,complex regional pain syndromes,bariatric pain,analgesics,anaesthesiology,addictive

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