Is Non-Opioid Anesthesia Better Than Opioid-Based Anesthesia?

An anesthetic is a drug used to create a safe loss of consciousness. These drugs are frequently used during surgeries and numerous other minimally invasive procedures to keep patients calm and comfortable. While anesthetics can be given in numerous forms, including topical applications and oral formulas, the option most commonly used for major surgeries is known as general anesthesia.

Understanding General Anesthesia

Rather than giving a patient a single drug, surgeons and anesthesiologists today generally give a mixture of drugs as a general anesthetic (typically called a cocktail). By giving a variety of drugs, anesthesiologists can eliminate some of the side effects of single drugs, provide a better and more healthful state for the patient during surgery and create the preferred level of consciousness during the procedure.

What Are the Purposes of Anesthetics?

Although patients describe anesthesia as making them feel as if they are asleep, these drugs do much more than simply putting someone to sleep. They stop the brain from receiving signals about pain and from responding reflexively to other stimuli. Most times, these drugs also reduce pain and cause the patient to be unable to remember anything about the procedure.

In particular, these drugs, which are given as injections or as continuous drips through an intravenous line, are used for long procedures that could lead to significant blood loss or require a very cold environment for success. At Edgewood Surgical Hospital, these drugs are most often used for involved orthopedic surgeries.

Opioid Analgesics

Traditionally, opioid analgesics were the most frequently chosen general anesthetics because they seemed to work so well. Opioid agents dull pain greatly and work by blocking the nerve path that translates the sensation of pain to the brain. Specifically, they bind themselves to certain pain receptors throughout the peripheral and central nervous systems depending on the specific opioid.

Common Opioid Analgesics

There are numerous opioid analgesics that have been used for surgical procedures for years. The most common options have been fentanyl, morphine and hydromorphone. These have also been frequently given during the post-operative period to reduce pain. Fentanyl works the fastest and is easy for an anesthesiologist to dose. Morphine begins working in as little five minutes while hydromorphone takes longer. Because fentanyl is incredibly potent, it has been the favored opioid analgesic for years.

In addition to these three commonly seen options, anesthesiologists have a wide range of other opioids to use during surgery, as well. Such options (like sufentanil, remifentanil and alfentanil) are used only during surgery and are incredibly potent when compared to morphine.

Problems with Opioids

Despite their long history of usage in surgical centers across the country, opioids as traditional painkillers are rapidly falling out of favor. Even though the national opioid crisis is just now beginning to highlight the problems associated with opioids, surgeons and anesthesiologists have long been concerned with some of their distressing side effects.

The most common and concerning side effects of opioids include respiratory depression and increased sedation. In laymen’s terms, this means that these drugs slow down the rate at which a patient breathes while also decreasing level of consciousness. These side effects can have devastating consequences in some cases and can keep a patient from getting the oxygen needed to nourish the many tissues throughout his body.

However, most opioids come with a laundry list of other concerning side effects, such as constipation, itchiness, nausea and decreased urination. Over time, patients can become dependent on these drugs, making it difficult to stop taking them if they have used them for some time after surgery.

Non-Opioid Analgesics

An interesting alternative to opioid analgesics are non-opioid drugs (which produce similar effects). Non-opioid anesthesia can also treat moderate to severe pain during and after surgery. These drugs work on similar points in the body’s pain pathway to decrease the sensation of pain in the brain and eliminate natural reflexes that could be harmful during surgery.

Common Non-Opioid Analgesics

There are four common options for non-opioid anesthesia that can be used during and after surgery. Dexmedetomidine is a fast-acting sedative that is only given intravenously. It can be easily titrated during surgery and is particularly useful in treating pain for those who have a history of chronic pain.

Two non-opioid options that are typically used at the end of surgery are IV acetaminophen and ketorolac. Ketorolac is a type of non-steroidal anti-inflammatory drug that can be quite useful for controlling severe pain following surgery, as well.

Finally, ketamine is a type of sedative and hypnotic agent that works quickly during surgery and that can significantly improve post-operative pain. Unlike its opioid counterparts, ketamine actually opens up the airways to improve respiration.

Benefits of Using Non-Opioids

There are several clear benefits to using non-opioid anesthesia along with or instead of its traditional counterparts. These drugs work better for patients who may have a long history of opioid use for chronic pain and who may have a high tolerance for these traditional drugs. In addition, non-opioid agents tend to result in fewer post-operative complications with breathing and decreased consciousness and can allow patients to get back to their baselines as quickly as possible.

A Combination Approach for Surgical Anesthetics

Today, the American Society of Anesthesiologists and the American Association of Nurse Anesthetists both recommend a multimodal path for appropriate analgesia during surgery. With a multimodal approach, a patient can receive a mixture of opioid agents as well as non-opioid agents to enjoy the quick comfort of pain relief from the opioids along with the long-acting yet safe effects from the non-opioid analgesics. 

These combination therapies allow providers to give patients smaller doses of all medications, which can decrease the risk of common side effects, such as nausea, constipation and bleeding. Some surgeons also choose to use spinal blocks to further eliminate peri-operative pain without a major dependence on opioids.

Edgewood Surgical Hospital Is Here to Help

At Edgewood Surgical Hospital, we perform complete pre-operative patient assessments to determine which drugs would be safest and best for each patient. We will look at current health conditions, current medications and supplements and overall goals for pain control. Our goal for each patient is complete comfort throughout the peri-operative and post-operative experience so that every individual can get back to his daily life as quickly as possible.

We encourage you to learn more about Edgewood today and see how we can help you with your next procedure. With the lowest infection rates in the state and incredibly high patient satisfaction scores, we know you will be just as impressed by our facility as previous patients have been.