Abstract
The concept of balanced general anesthesia, which consists of unconsciousness, analgesia, and relaxation, the components of the “triad of anesthesia,” was first described by Cecil Gray in 1946 and was a big step forward in anesthesia and perioperative care. General anesthesia was performed using high doses of hypnotics or inhalation gases, which resulted in hemodynamic suppression and dangerous deep levels of anesthesia with concomitant morbidity and mortality. However, even with these high doses of anesthetic drugs, suppression of noxious or nociceptive stimuli was difficult. Therefore, the introduction of balanced anesthesia using different drugs to reach each desired goal was the first step in the development of multimodal analgesic and general anesthesia techniques that are applied in enhanced recovery after surgery (ERAS) pathways.
Pain pathways in the context of analgesia or antinociceptive strategies during anesthesia are very complex and multifactorial. Perioperative analgesia in relation to the postoperative pain management should ideally be included in the intraoperative period already and be a continuum postoperatively in order to have adequate postoperative pain relief and improved outcome. Multimodal or multitarget analgesia to control nociception intraoperatively with different classes of drugs will be the future in anesthesia and ERAS pathways in order to prevent nociceptive stimuli affecting the central system, reduce surgical stress, and prevent postoperative pain developing. In this chapter the intraoperative multimodal analgesia, including opioid and non-opioid additives within the context in multimodal anesthesia management, is outlined and discussed.
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References
Shafer SL. From d-tubocurarine to sugammadex: the contributions of T. Cecil Gray to modern anaesthetic practice. Br J Anaesth. 2011;107(1):97–102.
Wood A. New method of treating neuralgia by the direct application of opiates to the painful points. Edinb Med Surg J. 1855;82(203):265–81.
Mushin WW, Rendell-Baker L. Pethidine as a supplement to nitrous oxide anaesthesia. Br Med J. 1949;2(4625):472.
Jaquenoud P, Grolleau D, Cailarj DU. Clinical trials in anesthesia of Phentanyl (R-4263) AND Dehydrobenzperidol (R-4749). Agressologie. 1963;4:533–40.. Article in French.
de Boer HD, Detriche O, Forget P. Opioid-related side effects: postoperative ileus, urinary retention, nausea and vomiting, and shivering. A review of the literature. Best Pract Res Clin Anaesthesiol. 2017;31(4):499–504.
Kumar K, Kirksey MA, Duong S, Wu CL. A review of opioid-sparing modalities in perioperative pain management: methods to decrease opioid use postoperatively. Anesth Analg. 2017;125(5):1749–60.
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43(3):659–95.
Hudspith MJ. Anatomy, physiology and pharmacology of pain. Anaesth Intensive Care Med. 2016;17:425–30.
Millan MJ. Descending control of pain. Prog Neurobiol. 2002;66(6):355–474.
Cervero F. Visceral nociception: peripheral and central aspects of visceral nociceptive systems. Philos Trans R Soc Lond Ser B Biol Sci. 1985;308(1136):325–37.
Scott MJ, Baldini G, Fearon KC. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, Part 1: pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59(10):1212–31.
Feldheiser A, Aziz O, Baldini G, Cox BP, Fearon KC, Feldman LS, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289–334.
Benzon HT, Raja SN, Fishman SM, Liu SS, Cohen SP, editors. Essentials of pain medicine. 4th ed. Philadelphia: Elsevier; 2018. ISBN:978-323-40196-8.
Rabiner EA, Beaver J, Makwana A, Searle G, Long C, Nathan PJ, et al. Pharmacological differentiation of opioid receptor antagonists by molecular and functional imaging of target occupancy and food reward-related brain activation in humans. Mol Psychiatry. 2011;16(8):826–35, 785.
Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014;348:g1251.
Weibel S, Jelting Y, Pace NL, Helf A, Eberhart LH, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6:CD009642.
Estebe JP. Intravenous lidocaine. Best Pract Res Clin Anaesthesiol. 2017;31(4):513–21.
Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246–58.
Forget P, Cata J. Stable anesthesia with alternative to opioids: are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials. Best Pract Res Clin Anaesthesiol. 2017;31(4):523–31.
Tonner PH. Additives used to reduce perioperative opioid consumption 1: Alpha2-agonists. Best Pract Res Clin Anaesthesiol. 2017;31(4):505–12.
Bahr MP, Williams BA. Esmolol, antinociception, and its potential opioid-sparing role in routine anesthesia care. Reg Anesth Pain Med. 2018;43(8):815–8.
Gelineau AM, King MR, Ladha KS, Burns SM, Houle T, Anderson TA. Intraoperative esmolol as an adjunct for perioperative opioid and postoperative pain reduction: a systematic review, meta-analysis, and meta-regression. Anesth Analg. 2018;126(3):1035–49.
Ander F, Magnuson A, de Leon A, Ahlstrand R. Does the β-receptor antagonist esmolol have analgesic effects?: a randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test. Eur J Anaesthesiol. 2018;35(3):165–72.
Watts R, Thiruvenkatarajan V, Calvert M, Newcombe G, van Wijk RM. The effect of perioperative esmolol on early postoperative pain: a systematic review and meta-analysis. J Anaesthesiol Clin Pharmacol. 2017;33(1):28–39.
Matsuzaki S, Jardon K, Maleysson E, D’Arpiany F, Canis M, Botchorishvili R. Impact of intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment. Hum Reprod. 2012;27(6):1613–23.
Schietroma M, Carlei F, Cecilia M, Piccione F, Sista F, De Vita F, et al. A prospective randomized study of systemic inflammation and immune response after laparoscopic nissen fundoplication performed with standard and low-pressure pneumoperitoneum. Surg Laparosc Endosc Percutan Tech. 2013;23(2):189–96.
Sultana A, Torres D, Schumann R. Special indications for opioid free anaesthesia and analgesia, patient and procedure related: including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery. Best Pract Res Clin Anaesthesiol. 2017;31(4):547–60.
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de Boer, H.D. (2020). Analgesia During Surgery (Medications). In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_15
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DOI: https://doi.org/10.1007/978-3-030-33443-7_15
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