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Master Thesis

Anesthésie sans opioïde, consommation en morphine et faisabilité en chirurgie cardiaque : une étude rétrospective

Abstract : Main objectives:
To evaluate the effect on morphine requirements and the safety on the perioperative period in cardiac surgery of an opioid-free anesthesia (OFA) protocol. Methods:
We conducted a monocentric retrospective matched case-control cohort study at Rouen University Hospital. Each patient who benefited of a cardiac surgery under cardiopulmonary bypass with OFA protocol (dexmedetomidine, ketamine, lidocaine) between December 2018 and December 2019 were included (OFA group) and compare to a randomly selected cohort of patients with standard general with opioid anesthesia by remifentanil (OA group). A propensity score match (1:1) (by age, sex, Euroscore II, ASA score and type of surgery) was planned for the multivariate analysis. The primary outcome was the total morphine consumption in the 24 h after surgery. Secondary outcomes included analgesia items like pain score or non-opioid analgesic requirement, and safety items like occurrence of cardiac arrhythmia, severe conduction disorder or catecholamine requirement in perioperative period. Results: For the first analysis, 167 patients were included (OA = 100; OFA = 67). There were several differences between the two groups regarding the age (OA 72 [67, 75] vs OFA 68 years old [58, 74], p=0.007), the Euroscore II (OA 1.28 [0.93, 1.77] vs OFA 1.02 [0.80, 1.46], p=0.031), and the ASA score, with a higher proportion of ASA 3 score in the OFA group, and a higher proportion of ASA 4 score in the OA group (respectively OFA 82 vs OA 65 % and OFA 16 vs OA 34 %, p=0.043). The two groups were also not comparable about type of surgery, with more coronary artery bypass graft (CABG) in the OFA group, and more valvular surgery in the OA group (respectively OFA 53.7 vs OA 37.0 % and OFA 31.3 vs 50.0 %, p=0.026). For the other demographic data, there were no differences between the two groups. After propensity score analysis, each group had 48 patients, and were comparable for each preoperative characteristic. According to this analysis, the total consumption of morphine was higher in the OA group (OA 12 [10,16] vs OFA 1 [0, 5] mg, p<0.001). However, the postoperative consumption of morphine did not differ between the two groups (OA 0 [0, 5] vs OFA 0 [0, 3] mg, p=0.897). Time to extubation was also equivalent (OA 5 [4, 7] vs OFA 5 [3, 6] hours, p=0.562), along with ICU stay (OA 3 [2, 4] vs OFA 3 [2, 4] days, p=0.165). No difference was found in perioperative time regarding catecholamines need, arrhythmia or severe conduction disorder occurrence. In postoperative time, the two groups were comparable regarding pain score after the 24 first hours (and the maximum score during them), cognitive dysfunction, hypoxemia or pneumopathy occurrence. Conclusion: In this study, OFA protocol for general anesthesia was associated with a decrease of patients' s total morphine consumption, and does not appear to be associated with more significants side effects. Nevertheless, no differences were found in the usual morphine-attributable morbidity criteria. Prospective randomized trials with larger patient populations would be needed to explore any impact of a OFA protocol in cardiac surgery.
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Master Thesis
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Submitted on : Friday, March 26, 2021 - 10:38:47 AM
Last modification on : Tuesday, October 19, 2021 - 4:16:44 PM
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  • HAL Id : dumas-03182117, version 1


Pierre Schmidely. Anesthésie sans opioïde, consommation en morphine et faisabilité en chirurgie cardiaque : une étude rétrospective. Médecine humaine et pathologie. 2021. ⟨dumas-03182117⟩