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ESRA19-0566 Opioid-free anaesthesia for supratentorial craniotomy for tumor resection
  1. CT Chong
  1. Tan Tock Seng Hospital, National Healthcare Group, Anaesthesiology, Singapore

Abstract

Background and aims Opioids are frequently used for intra- and postoperative analgesia, and often unavoidable for major surgery. However, side effects of systemic opioids, including postoperative nausea/vomiting, postoperative hyperalgesia, neurologic and cardiorespiratory depression, and an association with tumor angiogenesis and recurrence are major concerns, especially for craniotomy for brain tumor resection.

Methods Post-craniotomy pain is generally described to be of moderate to severe intensity, but an anaesthetic technique relying primarily on regional scalp block and dexmedetomidine infusion is proposed as a means to obviate the use of opioids.

Results A 50-year-old ASA 2 patient underwent left craniotomy and excision of sphenoid-wing meningioma under general anaesthesia. Intra-operative monitoring instituted included ECG, SpO2, invasive arterial BP, ETCO2, bispectral index, rectal temperature and urine output. After a loading dose of IV 75 µg (equivalent to 1 µg/kg) dexmedetomidine over 10 min, induction and maintenance of anaesthesia was conducted with propofol TCI (effect-site, Schnider model). A selective left-sided scalp block using landmark technique with 12 ml 0.5% bupivacaine was performed. Intra-operative analgesia was afforded by IV dexmedetomidine infusion (0.2–0.7 µg/kg/hr) totalling 206 µg, IV magnesium sulphate 20mmol, IV paracetamol 1 g and the scalp block. Postoperatively, she spent one day in the ICU, requiring two doses of IV 1 g paracetamol before transfer to the general ward, where she required two doses of PO 1 g paracetamol. She required no further analgesia (including no opioid medications) during her 6 day hospitalization and was discharged well.

Conclusions Opioid-free anaesthesia is an appealing concept, and non-opioid analgesic adjuncts including dexmedetomidine in conjunction with scalp regional block may sufficiently achieve that.

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