ABSTRACT
Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.
Subject(s)
Analgesics, Opioid , Anesthesia , Analgesics, Opioid/adverse effects , Humans , Pain Management , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Perioperative CareABSTRACT
BACKGROUND AND AIMS: India is one of the five worst hit countries in the world due to COVID-19, by the fourth week of June 2020. The impact of COVID-19 on the health practices is well-documented but there are no studies assessing its impact on anesthesiologists in India. This study aims at assessment of the impact of COVID-19 on the practices followed, the preparedness, and mindset of anesthesiologists in India. MATERIAL AND METHODS: Using Google forms, a cross-sectional, questionnaire-based survey was conducted between the 5th and 22nd of May, 2020, among trainees and practicing anesthesiologists, in India. The anesthesiologists were invited to participate, using their e-mail addresses and through the social media platforms such as Facebook and WhatsApp. The responses that were generated, were analyzed using SPSS version 23 (IBM, Armonk, NY). RESULTS: Of the 707 anesthesiologists who participated, 68.3% had already worked in a COVID-19 specialty unit. Only 41.7% of the anesthesiologists felt confident that they had sufficient knowledge to deal with COVID-19 infected patients. Fear of catching the infection and infecting loved ones were important causes of anxiety, which was seen in 95% of the participants. Majority of the participants, (64.5%) did not think that elective surgical procedures could be restarted at this point. CONCLUSION: COVID-19 has had grave impact on anesthesiologists, on the professional and personal front, and will possibly cause near-permanent changes in the work culture. Restarting elective surgical procedures, will require meticulous planning. In spite of their self-perceived under-preparedness to combat COVID-19, an overwhelming majority of participating anesthesiologists were prepared to contribute to the management of COVID-19.
ABSTRACT
BACKGROUND AND AIMS: Patients undergoing ovarian cancer surgery after chemotherapy and requiring opioid-based patient-controlled analgesia (PCA) are at high-risk of postoperative nausea and vomiting (PONV). We aimed to assess the effect of palonosetron and dexamethasone combination for these patients for prevention of PONV. METHODS: This study included 2 groups and 150 patients. At the time of wound closure, patients in group A received ondansetron 8 mg intravenous (IV) + dexamethasone 4 mg IV and group B received palonosetron 0.075 mg IV + dexamethasone 4 mg IV. Postoperatively for 48 hours, group A patients received ondansetron 4 mg 8 hourly IV, group B patients received normal saline 8 hourly IV in 2 cc syringe. The primary objective was the overall incidence of PONV. Independent t-test, Chi-square test, and Fisher's exact test were used and multivariate regression analysis was done. RESULTS: Vomiting was significantly higher in group A (37.3%) as compared with group B (21.3%) at 0-48 hours (P = 0.031). Significantly more patients in Group A had nausea as compared with group B at 90-120 minutes (30.66% vs 18.66%, P = 0.043) and 6-24 hours (32.0% vs 22.66%, P = 0.029). PCA opioid usage in microgram was significantly higher in group A at 0-24 hours (690.53 ± 332.57 vs 576.85 ± 250.79, P = 0.024) and 0-48 hours (1126.10 ± 512.18 vs 952.13 ± 353.85, P = 0.030). CONCLUSION: Palonosetron with dexamethasone is more effective than ondasetron with dexamethasone for prevention of PONV in post-chemotherapy ovarian cancer surgeries receiving opioid-based patient controlled analgesia.
