# The Efficiency of Multimodal Opioid-Free Anesthetic Management in a Patient Undergoing Major Abdominal Surgery - Case Report

## TL;DR

This case report describes a successful opioid-free anesthesia approach using multiple local anesthetics for a complex abdominal surgery, aiming to avoid opioid-related complications.

## Contribution

The paper presents a practical case of opioid-free multimodal anesthesia using MILANA for major abdominal surgery, highlighting its effectiveness in pain management.

## Key findings

- The use of multiple local anesthetics (MILANA) provided superior pain relief without opioids.
- The patient experienced fewer opioid-related complications such as ileus and respiratory depression.

## Abstract

Opioid-free anesthesia has become a purposeful alternative to addressing nociception in the perioperative settings. Increased opioid availability has been accompanied by an opioid crisis. Around 1.6 million Americans had an opioid dependence problem in 2019 with 70,000 people dying from overdose every year. The concept of multimodal anesthesia aims to avoid the negative effect of opioid use intraoperatively on the patient’s postoperative outcomes. Though adverse sequelae such as ileus, respiratory depression, somnolence, immunosuppression and hyperalgesia are well documented in the literature, the use of diverted prescription opioids can result in addiction or fatal overdose. In recent years concerned researchers and physicians tried to identify practical strategies to a more cautious opioid use and even an opioid free approach. A multidisciplinary perioperative care plan that includes a preoperative evaluation, an intraoperative and postoperative care strategy needs to be formulated. In this case report, we describe pertinent considerations in tailoring a successful opioid sparing analgesia technique that provided superior pain relief using multiple interventions of local anesthetics (MILANA) for a patient undergoing a complex abdominal surgery.