Opioid Free Anesthesia with Goal-Directed Strategies Based On Monitoring For Spine Surgery in a Patient with Opioid Intolerance: A Case Report

Abstract

This study aimed to report the use of a multimodal anesthetic (MA) regimen by combining a panoply of drugs without opioids for posterior spinal fusion surgery in a patient with Low-back incapacity and opioid intolerance. The surgery occurred without incidents nor do hemodynamic instabilities, except for a delay in waking up, reverse with extra doses of decurarizing. On the 13th day, she reported mild pain (VAS 2/10) and was satisfied with the result of the surgery. This case report highlights the new concept of using manifold drugs through the use a goal-direct strategies based on monitoring. Furthermore, we emphasize the use of good monitoring, such as ANI and IGP, for the success of this type of surgery. Scale; LIF: Lumbar Interbody Fusion; ALIF: Anterior Lumbar Interbody Fusion; PLIF: Posterior Lumbar Interbody Fusion; ERAS: Enhanced Recovery After Surgery; ANS: Autonomic Nervous System; OFA: Opioid-Free Anesthesia; BIS: Bispectral Index; TOF: Train-Of-Four; ANI: Analgesia Nociception Index; ICG: Impedance Cardiography; SV: Systolic Volume; HR: Heart Rate; CO: Cardiac Output; VET: Ventricular Ejection Time; MAC: Minimum Alveolar Concentration; PACU: Post-anesthesia Care Unit; AHT: Arterial Hypertension; CNS: Central Nervous System.