# Is a Perioperative Opioid-Sparing Anesthesia-Analgesia Strategy Feasible in Open Thoracotomies? Findings from a Retrospective Matched Cohort Study

## TL;DR

This study found that using fewer opioids during and after thoracic surgery can reduce pain and recovery time without regional nerve blocks.

## Contribution

The study demonstrates the feasibility of opioid-sparing anesthesia-analgesia in thoracotomies without regional blocks.

## Key findings

- OSA-A reduced postoperative pain and opioid use compared to standard opioid-based techniques.
- Patients in the OSA-A group had shorter PACU stays and better gastrointestinal recovery.
- No significant differences in chronic pain prevalence were found between groups.

## Abstract

Background/Objectives: To assess the feasibility and effectiveness of a perioperative opioid-sparing anesthesia-analgesia (OSA-A) technique without regional nerve blocks compared to standard opioid-based technique (OBA-A) in open thoracotomies. Methods: This retrospective, matched cohort study was conducted at a university hospital from September 2019 to February 2021, including adult patients undergoing open thoracotomy for lung or pleura pathology. Sixty patients in the OSA-A group were matched with 40 in the OBA-A group. Outcomes included postoperative pain scores on days 0, 1, and 2; 24-h postoperative morphine consumption; PACU and hospital length of stay; time to bowel movement; and rates of nausea and vomiting. Results: Of 125 eligible patients, 100 had complete records (60 OSA-A, 40 OBA-A). Demographics were similar, but ASA status scores were higher in the OBA-A group. The OSA-A group reported significantly lower pain levels at rest, during cough, and on movement on the first two postoperative days, shorter PACU stay, and required fewer opioids. They also had better gastrointestinal motility (p < 0.0001) and lower rates of nausea and vomiting on postoperative days 1 and 2. A follow-up study with 68 patients (46 OSA-A, 22 OBA-A) assessing chronic pain prevalence found no significant differences between the groups. Conclusions: OSA-A without regional nerve blocks for open thoracotomies is feasible and safe, improving postoperative pain management, reducing opioid consumption, shortening PACU stay, and enhancing early gastrointestinal recovery compared to OBA-A.