There has been a decrease in intraoperative opioid use due to the twin concerns of opioid induced hyperalgesia and acute opioid tolerance especially with short acting agents. Opioid free anesthesia is common with various combinations of agents like Dexmedetomidine, Lidocaine, and Ketamine.
The pendulum sometimes swings too far, as is echoed by laws and restrictions on opioid prescription resulting in inappropriate sudden opioid discontinuation.
This analysis evaluated the association of intraoperative fentanyl dose and postoperative respiratory complications within 3 days after surgery (defined as reintubation, respiratory failure, pneumonia, pulmonary edema, or atelectasis).
Intraoperative low-dose fentanyl (about 60–120 μg for a 70 kg patient) was associated with lower risk of postoperative respiratory complications compared with both no fentanyl and high-dose fentanyl. Beneficial effects of low-dose fentanyl were augmented in thoracic surgery, and with high dose inhalational anaesthetics and neuromuscular blocking agents. A randomized controlled study might clarify the significance of these findings.