Comparison of Recurrence of Malignancy Following Two Opioid-free General Anesthesia Regimens versus Standard Care Using Opioids: A Retrospective Analysis.

Avoiding opioids and volatile anesthetics during surgery may reduce immunosuppression. In patients with advanced head-and-neck malignancies undergoing excision with reconstruction, those who received an opioid-free anesthesia regimen using intravenous lidocaine had a significantly lower rate of cancer recurrence within one year after surgery compared to those who received a regimen using dexmedetomidine with ketamine or standard morphine-based anesthesia. Hospital stay was also shorter in the lidocaine group. Durations of surgery and intensive care unit stay were similar across groups, and mortality at one year was comparable.

Study at a glance

Abstract

Immunosuppressant effects of anesthesia can be reduced by avoiding opioids and volatile anesthetics. We retrospectively compared incidence of recurrence of malignancy in patients with advanced head-and-neck malignancies who had undergone excision with reconstruction surgery 1 year back and had received two different regimens of opioid free anesthesia (OFA) versus standard regimen using morphine. Durations of surgery, intensive care unit (ICU), and hospital stay and mortality at 1 year were also compared. Retrospective analysis conducted in 150 patents comprising of three equal groups. Group L had received intravenous lidocaine bolus 1.5 mg/kg followed by infusion 1 mg/kg/h. Group D received intravenous dexmedetomidine 1 mcg/kg bolus with ketamine 0.5 mg/kg followed by dexmedetomidine 0.5 mcg/kg/h with ketamine 0.5 mg/kg/h infusion. Group M received morphine 0.2 mg/kg bolus followed by an infusion 2 mg/h. The disease process at 1 year following surgery was assessed by reviewing medical records and contacting the patient or relative telephonically. Mean durations of surgery and ICU stays were comparable in all three groups. Duration of hospital stay was significantly lower in Group L. Patients in all groups had comparable regular postoperative follow-up visits. Incidence of recurrence of malignancy within 1 year of surgery was significantly lower in Group L. Mortality was comparable in all three groups. Patients with advanced carcinoma of tongue and buccal mucosa who received OFA using lidocaine during surgery demonstrated a significantly lower recurrence rate of malignancy at 1 year postoperatively compared to those who received OFA regimen utilizing dexmedetomidine with ketamine and traditional anesthesia with opioids.