Opioid-free anaesthesia for lung cancer resection: a case-control study

Abstract Objective To assess the feasibility and effectiveness of an opioid-free anaesthesia (OFA) technique in lung cancer resection surgery versus standard opioid-based techniques. Design Retrospective, propensity-matched, case-control study. Setting A single, specialist cardiothoracic centre between January 2018 and July 2019. Participants Adult patients undergoing lung cancer resection surgery. Interventions A cohort of 83 patients undergoing an OFA technique (Group OFA) for lung cancer resection surgery was matched with 83 patients who underwent similar surgery with a standard anaesthesia technique (Group STD). Outcome measures compared between the two groups included postoperative pain scores at 0, 1 and 24 hours, 24 hour post-operative morphine PCA consumption, recovery room and hospital length of stay and 30 day all-cause mortality. Measurement and Results We found no difference in median pain scores (Inter Quartile Range IQR) at 0h: STD 0 (0-1), OFA 0 (0-1), p = 0.48. Median pain scores (IQR) at 1h were statistically significantly higher in group STD compared to group OFA: STD 1 (0-1), OFA 0 (0-1), p = 0.03. There was no difference in median pain scores (IQR) at 24h: STD 0 (0-1), OFA 0 (0-1), p = 0.49. Mean postoperative 24-hour PCA morphine consumption (SD) was similar between groups: STD 21.1 (± 18.8) mg, OFA 16.2 (± 18.1) mg, p = 0.16. There was no difference in mean time spent in the postoperative recovery (SD) area between the two groups: STD 116 (± 49) min, OFA 108 (± 34) min, p = 0.27. Median hospital length of stay (IQR) was longer in group STD compared to group OFA: STD 4 (2-6) days, OFA 3 (2-4) days, p = 0.002. Conclusions This case-control study demonstrates that an OFA technique in lung cancer resection surgery offers a feasible and safe approach, resulting in similar post-operative pain scores and morphine consumption compared with standard opioid-containing techniques.