• Susan A Smith, Hussam Ghabra, Daniah G Dhaifallah, Alexander Rahnema, Bryan M Evans, Bobby D Nossaman, William D Sumrall, Stephen F Bardot, and Daniel J Canter.
• From the Department of Anesthesiology, Emory University, Atlanta, Georgia, the Departments of Anesthesiology and Urology, Ochsner Clinic Foundation, New Orleans, Louisiana, the Department of Anesthesiology, Critical Care, & Pain Medicine, St Elizabeth's Medical Center, Brighton, Massachusetts, and the Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock.
• South. Med. J. 2020 Oct 1; 113 (10): 499-504.

ObjectivesWe postulated that an opiate-free (OF) general anesthesia (GA) technique could adequately control a patient's pain without adversely affecting recovery. We compared patients undergoing major urologic procedures with and without opiate-based GA.MethodsA propensity-matched analysis was performed comparing hospital length of stay, postoperative nausea and vomiting, ileus occurrence, postanesthesia care unit, and total opiate consumption, as well as sedation and hemodynamic variables. The data are expressed as medians and were analyzed with the Wilcoxon rank-sum test. P < 0.05 indicate statistical significance.ResultsIn total, 166 patients were evaluated in both the OF group and the opiate-based treatment group. American Society of Anesthesiologists classification and age were comparable, with most surgeries being laparoscopic and confined to the bladder, kidney, and prostate gland. The median opiate consumption in morphine equivalents in the postanesthesia care unit was 7.7 mg (range 5-11.7 mg) for the OF cohort versus 11.7 mg (range 5-17.3 mg) for the control group (P < 0.001). Similarly, the median total postoperative opiate consumption in morphine equivalents was 23.9 mg (range 13.8-42.4 mg) for the OF group compared with 32.1 mg (range 17.38-57.51 mg) for the control group (P = 0.0081). The median hospital length of stay for the OF group was 1.4 days (range 1.2-2.3 days) versus 1.3 days (range 1.2-2.4 days) for the control group (P = 0.8466).ConclusionsThere was a statistically significant difference in opiate consumption postoperatively for patients who underwent an OF technique compared with a conventional opiate-based technique. This technique appears to be a possible alternative approach, without any apparent untoward consequences during admission.

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