Multimodal opioid sparing onco-anesthesia: A consensus practice guideline from Society of Onco-Anesthesia and Perioperative Care (SOAPC)

Authors

  • Sohan Lal Solanki, MD, PDCC, MAMS https://orcid.org/0000-0003-4313-7659
  • Raghu S. Thota, MD, MAMS https://orcid.org/0000-0001-8945-2174
  • Jeson Rajan Doctor, MD, DNB, MNAMS
  • Gauri Raman Gangakhedkar, DNB
  • Parmanand Jain, MD, MAMS
  • Vijaya Gottumukkala, MD
  • Rakesh Garg, MD
  • Juan P. Cata, MD
  • Jyotsna Goswami, MD
  • Namrata Ranganath, MD
  • Seshadri Ramkiran, DA, DNB
  • Babita Ghai, MD
  • Keyuri U. Popat, MD
  • Donal J. Buggy, MD
  • Anjali A. Pingle, DNB, FRCA
  • Vaibhavi Baxi, DNB
  • Basanth Kumar Rayani, MD
  • Mary Thomas, DA, DNB
  • Sushma Bhatnagar, MD
  • Jigeeshu V. Divatia, MD, FCCM

DOI:

https://doi.org/10.5055/jom.2021.0675

Keywords:

analgesics, opioid, breakthrough pain, consensus, opioid-related disorders, pain, post-operative

Abstract

Opioids are an indispensable part of perioperative pain management of cancer surgeries. Opioids do have some side effects and abuse potential, and some laboratory data suggest a possible association of cancer recurrence with perioperative opioid use. Opioid-free anesthesia and opioid-sparing anesthesia are emerging new concepts worldwide to safeguard patients from adverse effects of opioids and potential abuse. Opioid-free anesthesia could lead to ineffective pain management, leaving the perioperative physician with limited options, while opioid-sparing anesthesia may be a rational approach. This consensus guideline includes general considerations of the safe use of perioperative opioids along with concomitant use of central neuraxial or regional blockade and systematic nonopioid analgesics. Region-specific onco-surgeries with their specific recommendations and consensus statements for judicious use of opioids are suggested. Use of epidural analgesia or regional catheter during thoracic, abdominal, pelvic, and lower limb surgeries and use of regional nerve blocks/catheter in head neck, neuro, and upper limb onco-surgeries, wherever possible along with nonopioids analgesics, are suggested. Short-acting opioids in small aliquots may be allowed to control breakthrough pain for expedient control of pain. The purpose of this consensus practice guideline is to provide the practicing anesthesiologists with best practice evidence and consensus recommendations by the expert committee of the Society of Onco-Anesthesia and Perioperative Care for safe opioid use in onco-surgeries.

Author Biographies

Sohan Lal Solanki, MD, PDCC, MAMS

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Raghu S. Thota, MD, MAMS

Department of Anesthesiology, Critical Care and Pain, Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute, Navi-Mumbai, Maharashtra, India

Jeson Rajan Doctor, MD, DNB, MNAMS

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Gauri Raman Gangakhedkar, DNB

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Parmanand Jain, MD, MAMS

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Vijaya Gottumukkala, MD

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas

Rakesh Garg, MD

Department of Onco-Anesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India

Juan P. Cata, MD

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas

Jyotsna Goswami, MD

Department of Anesthesiology, Critical Care Medicine and Pain, Tata Medical Center, Kolkata, West Bengal, India

Namrata Ranganath, MD

Department of Anesthesia and Pain Relief, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Seshadri Ramkiran, DA, DNB

Department of Anesthesiology, Homi Bhabha Cancer Hospital & Research Center, Homi Bhabha National Institute, Visakhapatnam, Andhra Pradesh, India

Babita Ghai, MD

Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Keyuri U. Popat, MD

Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas

Donal J. Buggy, MD

Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland

Anjali A. Pingle, DNB, FRCA

Department of Anesthesiology, PD Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India

Vaibhavi Baxi, DNB

Department of Anesthesiology, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India

Basanth Kumar Rayani, MD

Department of Anaesthesiology, Pain and Palliative Care, Basavatakaram Indo American Cancer Hospital and Research Institute, Hyderabad, India

Mary Thomas, DA, DNB

Department of Anaesthesia, Regional Cancer Centre, Thiruvananthapuram, Kerala, India

Sushma Bhatnagar, MD

Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, Dr BRAIRCH, New Delhi, India

Jigeeshu V. Divatia, MD, FCCM

Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

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Published

09/01/2021

How to Cite

Solanki, MD, PDCC, MAMS, S. L., R. S. Thota, MD, MAMS, J. R. Doctor, MD, DNB, MNAMS, G. R. Gangakhedkar, DNB, P. Jain, MD, MAMS, V. Gottumukkala, MD, R. Garg, MD, J. P. Cata, MD, J. Goswami, MD, N. Ranganath, MD, S. Ramkiran, DA, DNB, B. Ghai, MD, K. U. Popat, MD, D. J. Buggy, MD, A. A. Pingle, DNB, FRCA, V. Baxi, DNB, B. K. Rayani, MD, M. Thomas, DA, DNB, S. Bhatnagar, MD, and J. V. Divatia, MD, FCCM. “Multimodal Opioid Sparing Onco-Anesthesia: A Consensus Practice Guideline from Society of Onco-Anesthesia and Perioperative Care (SOAPC)”. Journal of Opioid Management, vol. 17, no. 5, Sept. 2021, pp. 417-3, doi:10.5055/jom.2021.0675.

Issue

Vol. 17 No. 5 (2021): September/October

Section

Review Articles

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