Opioid-free anaesthesia tied to better outcomes in DIEP flap reconstruction

In deep inferior epigastric perforator (DIEP) flap reconstruction, opioid-free anaesthesia (OFA) with goal-directed fluid therapy and opioid anaesthesia (OA) with liberal fluid therapy do not differ in terms of major complications, a recent study has found. However, OFA seems to be better for minor complications, pain, and nausea,

The retrospective study included 204 eligible patients, of whom 55 received OFA and 149 were given OA. The primary study outcome was the occurrence of complications, as defined by the Clavien-Dindo (CD) classification, as well as the length of hospital stay. Secondary outcomes included postoperative nausea and vomiting (PONV), pain, opioid consumption, skin flap temperature, along with flap failure.

Minor classifications, graded I and II on Clavien-Dindo, occurred significantly more commonly in the OA group (51.4 percent vs 17.9 percent; p<0.001). In particular, where nine episodes of grade 2 complications were detected in OA patients, none were recorded in OFA. The frequency of major complications (grades III–V) was comparable between groups.

OFA patients also required a significantly lower volume of intraoperative fluids. Postoperative nausea was likewise less frequent among patients given OFA (12.7 percent vs 43.6 percent; p<0.001), as was the need for prophylactic and therapeutic antiemetic drugs (p<0.001 for both).

In addition, 60 percent of OFA patients did not use opioids postoperatively, a significantly greater proportion than that in the OA group (12.7 percent; p<0.001).

Regression analyses further confirmed that OFA patients saw a significantly lower incidence of PONV, had shorter length of hospital stay, had lower CD ranking, and had lower postoperative visual analogue scale pain rating than OA counterparts.