We should be careful not to swing the pendulum too far as is always done when something "new" comes up. There has not been any evidence that intraop opioids is an issue but rather postop. So though you need to plan for postop pain, avoiding opioids totally is not reasonable or feasible. I may be old school but I still give T&A patients opioids and so far there has not been any who had respiratory issues postop, even the ones who were admitted for overnight monitoring based on criteria (e.g., age, severe OSA, obesity). Caveat, everything should be administered judiciously and with thought.
Thanks Fran for the balanced view of this conundrum. Do intraoperative opioids cause any harm postoperatively? Does their administration contribute to postop hyperalgesia, setting up a vicious cycle of pain and pain relief? Or does the administration of intraop opioids make the anesthesia provider feel better because the vital signs have stabilized? Blinded studies in adults have shown the same results when substituting esmolol for fentanyl. Great questions! No convincing evidence...yet.
We should be careful not to swing the pendulum too far as is always done when something "new" comes up. There has not been any evidence that intraop opioids is an issue but rather postop. So though you need to plan for postop pain, avoiding opioids totally is not reasonable or feasible. I may be old school but I still give T&A patients opioids and so far there has not been any who had respiratory issues postop, even the ones who were admitted for overnight monitoring based on criteria (e.g., age, severe OSA, obesity). Caveat, everything should be administered judiciously and with thought.
Thanks Fran for the balanced view of this conundrum. Do intraoperative opioids cause any harm postoperatively? Does their administration contribute to postop hyperalgesia, setting up a vicious cycle of pain and pain relief? Or does the administration of intraop opioids make the anesthesia provider feel better because the vital signs have stabilized? Blinded studies in adults have shown the same results when substituting esmolol for fentanyl. Great questions! No convincing evidence...yet.