Anesthesia in Colorectal Oncologic Surgery: Opioids, Low Dose and No Opioids
Colorectal cancer surgery requires careful pain management to improve postoperative recovery and reduce complications. The anesthetic approach can have a significant impact on patient recovery and long-term outcomes. We review here three main anesthetic strategies: traditional opioid use, low-opioid techniques, and completely opioid-free strategies.
Traditional opioid-based anesthesia is widely used for its effectiveness in controlling acute pain. Opioids, such as morphine, fentanyl and oxycodone, provide immediate and potent relief, which is essential in the immediate postoperative phases of major surgery.
Advantages:
- Effective and rapid pain control.
- Wide experience and familiarity among anesthesiologists.
Disadvantages:
- Risk of respiratory depression.
- Possible side effects such as nausea, vomiting, constipation, and itching.
- Potential for the development of tolerance or dependence.
Low Opioid Content Anesthesia
This approach seeks to minimize opioid use by combining small doses with other analgesics, such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and calcium channel blockers. The goal is to reduce the side effects of opioids while maintaining adequate pain control.
Advantages:
- Fewer side effects than high opioid regimens.
- Reducing the risk of addiction.
- Improved early mobilization and resumption of bowel function.
Disadvantages:
- Potentially less effective for severe pain without optimal adjustment of dosage and drug combination.
Anaesthesia Without Opioids
Opioid-free anesthesia uses non-opioid alternatives to manage pain, such as lidocaine IV, ketamine, magnesium and regional nerve blocks. This strategy is geared toward faster recovery and reduced hospital stay time.
Advantages:
- Elimination of risks associated with opioids, including gastrointestinal and respiratory side effects.
- Potentially shorter hospitalization time.
Disadvantages:
- Challenges in controlling severe pain, especially in patients with high pain threshold.
- Needs staff experienced in advanced anesthetic techniques.
The choice of anesthetic approach in colorectal cancer surgery depends on many factors, including the nature of the surgery, the patient's preexisting conditions, and the skills of the anesthetic team. While opioid use continues to be a mainstay for the control of severe pain, low-opioid and opioid-free strategies are gaining popularity as effective alternatives that can offer significant benefits in terms of recovery and reduction of side effects. Multidisciplinary collaboration in anesthesia planning can help personalize pain treatment, maximizing patient benefits and optimizing surgical outcomes.
