Vol 6 | Issue 1 | January-April 2020 | page: 13-18 | Imran Ahmed Khan, Shiv Kumar Singh
Author: Imran Ahmed Khan , Shiv Kumar Singh 
 Senior Resident, Sarkari Medicare Centre, Gorakhpur, UP, India
 Consultant Anaesthesia, Royal Liverpool University Hospitals, Prescot Street, Liverpool, L7 8XP.
Address of Correspondence
Dr. Shiv Kumar Singh,
Consultant Anaesthesia, Royal Liverpool University Hospitals, Prescot Street, Liverpool, L7 8XP
Efficacy, Safety And Patient Satisfaction Of A Simple Combination Of Readily Available Medications (Shiv-mix) For Perioperative Analgesia, Hemodynamic Stability And Postoperative Recovery Profile: Case Series And Narrative On Opioid Free Anaesthesia (OFA) In Spine Surgeries
Opioid-free anesthesia (OFA) is an emerging technique, is a boon especially for limited resource settings(LRS) where opioids availability is limited for perioperative pain management. The current study presents use of a combination of easily available medication as part of multimodal analgesia. These medications are easily available to any physician and our experience demonstrates that in addition to providing satisfactory analgesia, use of this combination also provides better hemodynamic stability and excellent post-operative recovery.
1. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016; 33(3):160–171.
2. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011; 377(9784):2215–2225.
3. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al: New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 152:e170504, 2017.
4. Martin JL, Koodie L, Krishnan AG, Charboneau R, Barke RA, and Roy S. Chronic morphine administration delays wound healing by inhibiting immune cell recruitment to the wound site. Am J Pathol. 2010; 176(2):786-
5. Sacerdote P. Opioids and the immune system. Palliat Med. 2006; 20 Suppl 1:s9-15.
6. Fodale V, D’Arrigo MG, Triolo S, Mondello S, and La Torre D. Anesthetic techniques and cancer recurrence after surgery. The Scientific World Journal. 2014; 2014: Article ID 328513.
7. Patil SK and Anitescu M. Opioid-free perioperative analgesia for hemicolectomy in a patient with opioid-induced delirium: a case report and review of the analgesic efficacy of the alpha-2 agonist agents. Pain Pract.
8. Fletcher D and Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014; 112(6):991-1004.
9. Mansour MA, Mahmoud AAA, Geddawy M: Nonopioid versus opioid based general anesthesia technique for bariatric surgery: a randomized doubleblind study. Saudi J Anaesth 7:387–391, 2013.
10. Lam KK, Mui WL: Multimodal analgesia model to achieve low postoperative opioid requirement following bariatric surgery. Hong Kong Med J 22:428–434, 2016.
11. Feld JM, Laurito CE, Beckerman M, Vincent J, Hoffman WE: Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can J Anaesth 50:336–341, 2003.
12. Ziemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT: Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth 112:906–911,
13. Kissin I. Pre-emptive analgesia. Anaesthesiology 2000; 93:1138-43.
14. Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. AnesthAnalg 1993; 77:362-79.
15. Kim DJ, Bengali R, Anderson TA. Opioid-free anesthesia using continuous dexmedetomidine and lidocaine infusions in spine surgery. Korean J Anesthesiol. 2017 Dec;70(6):652-653. doi: 10.4097/kjae.2017.70.6.652. Epub 2017 Apr 21. PMID: 29225750; PMCID: PMC5716825.
16. Apfel C.C., Turan A., Souza K., Pergolizzi J., Hornuss C. Intravenous acetaminophen reduces postoperative nausea and vomiting: A systematic review and meta analysis. PAIN 2013;154:677–689.
17. Delhumeau A, Granry JC, Monrigal JP, Costerousse F. Indications for the u s e o f m a g n e s i u m i n a n e s t h e s i a a n d i n t e n s i v e c a r e . AnnalesFranc¸aisesD’anesthe´sie-Re´animation 1995; 14: 406–16.
18. Mayer ML, Westbrook GL, Guthrie PB. Voltage-dependant block by Mg of NMDA response in spinal cord neurones. Nature 1984; 309: 261–3.
19. McCarthy RJ, Kroin JS, Tuman KJ, et al. Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulphate and morphine in rats. Anesthesia and Analgesia 1998; 86: 830–6.
20. Sun Y, Li T, Wang N et al. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 2012; 55: 1183–94.
21. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev 2000; 21:55– 89.
22. Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am CollSurg 2002; 195:694 –712.
23. Soffin EM, Wetmore DS, Beckman JD, Sheha ED, Vaishnav AS, Albert TJ et al (2019) Opioid-free anesthesia within an enhanced recovery after surgery pathway for minimally invasive lumbar spine surgery: a retrospective matched cohort study. Neurosurg Focus 46(4):E8
|How to Cite this Article: Khan I A, Singh S K | Efficacy, Safety And Patient Satisfaction Of A Simple Combination Of Readily Available Medications (Shiv-mix) For Perioperative Analgesia, Hemodynamic Stability And Postoperative Recovery Profile: Case Series And Narrative On Opioid Free Anaesthesia (OFA) In Spine Surgeries | Journal of Anaesthesia and Critical Care Case Reports | Jan-April 2020; 6(1): 13-18.|