#36447 Opioid free anesthesia to a patient in a drug rehabilitation program guided by the NOL index (Nociception Level Index)

Jason Kalyvas, Diamanto Dimitroula, Dimitris Iason Kalyvas, Amalia Douma, Christina Chantzi, Antonia Dimakopoulou
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Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA Prizes

Background and Aims

The perioperative pain management of patients in a drug rehabilitation program is a challenge, as trying to meet their needs in analgesia without bypassing the rehabilitation program. The opioid free anesthesia is gaining ground for these patients lately. The recent entry of the NOL index (Nociception Level Index) may constitute valuable aid in the intraoperative assessment of analgesia.

Methods

A 60-year-old man, with history of IV heroin dependence, in a methadone(70mg daily) rehabilitation program, ASA II, attended our hospital for cholecystectomy and bile duct exploration. Opioid free anesthesia was administered (according to Mulier protocol-Mullimix: 50μg dexmedetomidine, 500mg lidocaine, 50mg ketamine diluted in 100ml NS). Loading was done with 1μg/kg dexdemetomidine in 15 min and MgSO4 40mg/kg. Also parecoxib and dexamethasone were administered. Induction in anesthesia was carried out with Mullimix 0.2 ml/kg, propofol 2 mg/kg and rocuronium 0.6 mg/kg. The maintenance was done with desflurane and mullimix 0.2ml/kg/h initially, and the dose was titrated with maintaining the NOL ratio at values of 10-25. 2g of paracetamol were administered 30 min before the end of the operation and the wound was infiltrated with 40 ml of ropivacaine 0.375%. Methadone intake was continued throughout the perioperative period. Postoperative analgesia included paracetamol 4g and parecoxib 80mg daily.

Results

Pain assessment was performed in the PACU, and every 4 hours for the first 48 hours with NRS values (numerical rate scale) < 4. The patient received no other opioids.

Conclusions

Guided by analgesia monitoring, opioid free anesthesia can be an efficient method for patients in rehabilitation programs.
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在NOL指数(伤害感受水平指数)指导下,对一名戒毒康复患者进行无阿片类药物麻醉
申请ESRA摘要奖项:我不希望申请ESRA奖项背景和目的药物康复计划患者的围手术期疼痛管理是一个挑战,因为试图在不绕过康复计划的情况下满足他们在镇痛方面的需求。最近,无阿片类药物麻醉在这些患者中越来越流行。最近输入的NOL指数(伤害感觉水平指数)可能对术中镇痛评估提供有价值的帮助。方法60岁男性,有静脉海洛因依赖史,美沙酮(70mg / d) ASA II期康复治疗,于我院行胆囊切除术及胆管探查。给予无阿片类药物麻醉(按照mullier方案- mullimix:右美托咪定50μg,利多卡因500mg,氯胺酮50mg稀释于100ml NS中)。右美托咪定1μg/kg, MgSO4 40mg/kg, 15min装药。同时给予帕瑞昔布和地塞米松。采用Mullimix 0.2 ml/kg、异丙酚2 mg/kg、罗库溴铵0.6 mg/kg诱导麻醉。初始维持剂量为地氟醚和莫来莫混合液0.2ml/kg/h,以NOL比维持在10-25之间进行滴定。术后30 min给予扑热息痛2g, 0.375%罗哌卡因40 ml浸润创面。整个围手术期继续服用美沙酮。术后镇痛包括扑热息痛4g、帕瑞昔布80mg每日。结果在PACU中进行疼痛评估,前48 h每4 h用NRS值(数值率量表)<4. 患者未接受其他阿片类药物治疗。结论在镇痛监测的指导下,无阿片类药物麻醉是一种有效的康复方法。
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