Background and aims There are many compelling reasons to avoid opioid in the surgical population. Basic science would suggest that patients undergoing surgery for primary cancer may benefit from avoiding the inmunodepressent effect of opioids.
Methods We present 10 case reports of low dose opioid anesthesia undergoing laparoscopic colon surgery. Our patients received a low-dose-opioid-anesthesia using a preincisional loading dose of lidocaine 1.5 mg*Kg, Ketamina 0.5 mg*Kg and Dexametasona 8 mg. During surgery a TIVA with Propofol TCI 2,0–2,5, Lidocaine 1 mg*Kg, Ketamine 0.2 mg*Kg*h and a Remifentanil TCI 2–2.5 was performed. Before the end of the surgery NSAIDs, paracetamol 1 g and 0.05 mg*Kg dose of morfine was administered. As a multimodal analgesia program an interfascial catheter was implanted on the surgical wound that was used during the next 48 h in the postoperative period.
Results The mean VAS after extubation was 0 and also 2 hours later. One patient required 3 mg of morphine during his PACU stay. During the next 48 h after surgery the morphine consumption was zero.
Conclusions This result indicates that opioid sparing anesthesia with lidocaine, ketamine and propofol infusions decreased opioid requirements in the early postoperative period. Prolonged analgesic is obtained with interfascial catheter and NSAIDs. It has been reported that infusion of lidocaine in combination with low doses of opioids is associated with reduced intraoperative and postoperative opioid requirements.
Opioid sparing anesthesia is associated with lower morphine requirements in the early postoperative period. A multimodal analgesia regimen guarantees the lowest opioid requirement during postoperative period.
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