Standard Opioid-containing Versus Opioid-sparing Anesthesia On Early Postoperative Recovery After Video-assisted Thoracic Surgery:An Inverse Probability Weighted Analysis

Purpose:Opioids have several adverse effects,such as postoperative nausea and vomiting,respiratory depression,delirium,intestinal obstruction to hyperalgesia.Gradually more and more research on opioid-free anesthesia.Opioid-free anesthesia has recently been shown to have more adverse effects.Opioid-sparing anesthesia reduces opioid use by adjunctive to non-opioid analgesics.At present,there are no large clinical studies on the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery.This study was to investigate the effects of opioid-sparing anesthesia on early postoperative recovery after thoracoscopic surgery.Methods:Adult patients who underwent video-assisted thoracic surgery from 1 January 2019 to 28 February 2021 were enrolled by reviewing the electronic medical records.Participants were divided into opioid-sparing anesthesia(OSA group)and opioid-containing anesthesia(STD group)based on intraoperative opioid usage.The propensity-score analysis was to compare the early postoperative recovery of two groups.The outcome measurements included the incidence of postoperative nausea and vomiting(PONV)during an entire hospital stay,need for rescue antiemetic medication,postoperative-pain episodes within 48 h after surgery,need for rescue analgesia 48 h postoperatively,duration of postoperative hospital stay,length of PACU stay,postoperative fever,postoperative shivering,postoperative atrial fibrillation,postoperative pulmonary infection,postoperative hypoalbuminemia,postoperative hypoxemia,intraoperative blood loss,and intraoperative urine output.Results:A total of 1,975 patients were identified(STD groups,n=681,34.5%;OSA groups,n=1294,65.5%).No significant difference was observed in patient characteristics between the OSA and STD groups after adjusting for propensity score-based inverse probability treatment weighting(p>0.05).The incidence of postoperative nausea and vomiting was significantly lower in the OSA group than in the STD group(14.7%vs.18.9%,p=0.041).The rescue antiemetic use rate was lower in the OSA group than in the STD group(7.5%vs.12.2%;p=0.002).PACU duration was longer in the OSA group than in the STD group(70.8±29.0min vs.67.3±22.7min;p=0.016).The incidence of postoperative fever was higher in the STD group than that in the OSA group(11.0%vs.7.7%;p=0.032).The incidence of intraoperative atropine rate was lower in the STD group than that in the OSA group(38.3%vs.30.2%,p=0.002).There were no differences between the groups in terms of other outcomes(p>0.05).Conclusions:Our results suggest that opioid-sparing anesthesia in thoracoscopic thoracic surgery under general anaesthesia was associated with a lower incidence of nausea and vomiting,postoperative rescue antiemetic use,and postoperative fever than opioid-containing anesthesia.