Would reducing opioids during anesthesia make it possible to reduce the need to take strong analgesics during post-operative period? This is the question on which Doctor Vincent Collange, anesthesiologist-resuscitator at the Lyon-Villebanne (Ramsay Santé) in an innovative study. A research that could well upset current anesthetic practices and offer new perspectives to patients.
An innovative approach focused on the needs of patients
Traditionally, general anesthesia is based on three pillars: products that sleep patients, analgesic drugs (most often opioids derived from morphine), and drugs that prevent moving. However, this classic approach today raises important questions. “The use of opioids during anesthesia can create a form of dependence that increases the risk that patients need more to relieve pain,” explains Dr. Vincent Collange.
This reflection led him to take an interest in an opioid anesthesia technique developed by Professor Marc de Kock in Belgium, which he has adapted and put into practice for several years. This approach is based on a simple logic: since the pain requires being aware to be felt, and that an anesthetized patient is unconscious, why systematically use opioids?
From clinical idea to scientific study
Supported by the Ramsay Santé group and in collaboration with several colleagues from the Lyon-Villean Médipôle, Dr Collange transformed its practical experience of this technique into a research project. The objective: scientifically compare the anesthetic technique without opioids with the classic method and assess its real benefits for patients.
This controlled randomized study focused on 160 volunteer patients before undergoing a colectomy by laparoscopy (removal of part of the colon by mini-invasive surgery), divided into two groups. The first benefited from the classic anesthesia technique with morphine, the second of the technique favored by Dr Collange, without opioids.
How does anesthesia without opioid work?
“We replace opioids with other drugs that have analgesic virtues, as well as with drugs that modulate the body’s response,” explains Dr. Collange. The concept is based on the fact that under general anesthesia, there is no feeling of pain. To simplify, opioids act rather in the cerebral level to help accept pain, but if our nervous system has no interaction with pain during the intervention, we do not necessarily have an interest in using them. This approach makes it possible to maintain effective anesthesia while avoiding the potentially harmful effects of opioids on post-operative recovery.
Encouraging results
The results, published in a scientific journal in October 2024, are promising. “There is no significant difference between the two groups in terms of pain felt,” emphasizes Dr. Collange. This means that the new technique is not lower than the reference technique ”. Even more, a tendency to improve has been found in the group without opioids, even if it is not statistically significant due to the number of patients in the study.
The profits seem particularly interesting for the heaviest interventions requiring the longest anesthesia. “The more complex the operation, the more we have an interest in reducing the doses of opioids. It is on these populations that there are the most potential benefits, ”observes Dr. Collange.
What prospects for generalizing the reduction of opioids during anesthesia?
If the current results are encouraging, Dr. Collange remains cautious about the next steps. “It is difficult to highlight significant differences. It would take much more data to consider a phase 2. ”
In addition, the generalization of this approach still faces cultural resistance within the profession. “Sometimes there are reluctance related to established practices. Some colleagues prefer to stick to the protocols they master perfectly, recognizes the anesthesiologist. The objective of this study is precisely to provide scientific data to clarify these therapeutic choices and pave the way for new beneficial practices for patients. »»
This research perfectly illustrates the commitment of the Ramsay Health group to support medical innovation at the service of patients. By scientifically evaluating promising techniques and based on a rigorous scientific approach, Dr Collange and its teams open the way to a potentially more respectful anesthesia of the organization and promoting better post-operative recovery. An approach which, tomorrow, could well offer patients an interesting alternative to traditional anesthesia.
