An Evidence-Based Opioid-Free Anesthetic Technique to Manage Perioperative and Periprocedural Pain

Ochsner J. 2018 Summer;18(2):121-125. doi: 10.31486/toj.17.0072.


Background: The epidemic of opioid abuse is increasing, and the number of deaths secondary to opioid overdose is also increasing. Recent attention has focused on opioid prescribing and management of chronic pain. However, opioid use in perioperative and periprocedural patients, whether they have chronic pain or exhibit new persistent opioid abuse after a procedure, has received little attention.

Methods: We present an evidence-based technique that combines subanesthetic infusions of lidocaine and dexmedetomidine supplemented with other intravenous agents and a low dose of inhaled anesthetic.

Results: Based on evidence of drug action and interaction, an opioid-free anesthetic can be delivered successfully. We present the cases of 2 patients in whom the opioid-free anesthetic technique was used with a successful outcome, adequate pain management, and avoidance of opioid drugs.

Conclusion: This anesthetic prescription can be useful for opioid-naïve patients as well as for patients with chronic pain that is managed with opioids.

Keywords: Anesthesia; balanced anesthesia; dexmedetomidine; lidocaine; opioid-related disorders; perioperative care.