GP1b - Opioid-Free Anesthesia? Studying Patient Drug Preferences in the Oral and Maxillofacial Surgery Office

Abstract: Opioid-free anesthesia has become a widely discussed subject in the anesthesia field given the ongoing opioid epidemic. However, there are no studies examining patient preferences related to this technique. Understanding patient perceptions of sedation and anesthetics used in the ambulatory anesthesia setting may help guide the treatment decision making process. This study aims to assess patient familiarity and concerns regarding commonly used office anesthetics, with a focus on intraoperative and postoperative opioid use and other influencing factors.
This is a prospective observational survey conducted in Virginia Commonwealth University Department of Oral and Maxillofacial Surgery outpatient clinic. Subjects were consented for participation during their initial evaluation appointments and provided a 13-question survey. Primary outcome variables included degree of drug reservation for fentanyl, ketamine, versed, precedex, and propofol. Secondary and tertiary outcome variables included drug familiarity and reservations about postoperative opioid use. Predictor variables included social, medical, and demographic information (age, smoking, history of drug use, etc). Inclusion criteria consisted of adults over the age of 18 who were able to provide informed consent for participation.
Responses were summarized using descriptive statistics. Associations between predictive variables and outcome variables were analyzed using Wilcoxon rank-sum tests for continuous variables and chi-squared tests for categorical variables. All analyses were conducted using SAS EG v8.3 (SAS Institute, Cary, NC), with a significance level set at .05.
A total of 260 participants completed the survey with average age of participant was 45.5 with roughly even gender distribution, and 32% caucasian and 48% Black Americans. 30% had a history of substance abuse disorder, and 19% reported use of recreational drugs. 174 participants reported previous experience with sedation or anesthesia with 75% of those being unaware of the medication administered. Patients were most familiar with fentanyl (85%) followed by ketamine (59%). Half of patients had some reservation with using opioids for postoperative pain. Fentanyl showed the highest rate of reservations, with 29% of participants expressing some level of concern, a statistically significant difference when compared to other anesthetics, which had lower reservation rates. Caucasian participants demonstrated the highest rate of reservations, with a statistically significant association (P = .049).
Most patients either had no reservations or chose to defer the decision to the provider regarding the use of the specific drug under anesthesia. When reservations were expressed, the greatest concern arose with receiving fentanyl amongst caucasian patients. Most patients had reservations about postoperative opioid prescriptions. This insight can help providers make informed decisions about drug choices in their practice, specifically when considering opioid-free techniques.

References
Feenstra ML, Jansen S, Eshuis WJ, van Berge Henegouwen MI, Hollmann MW, Hermanides J. Opioid-free anesthesia: A systematic review and meta-analysis. J Clin Anesth. 2023;90:111215. doi:10.1016/j.jclinane.2023.111215
Kharasch ED, Clark JD. Opioid-free Anesthesia: Time to Regain Our Balance. Anesthesiology. 2021;134(4):509-514. doi:10.1097/ALN.0000000000003705
Figure 1: Self-Reported Familiarity with Various Sedation and Anesthesia Medications Figure 2: Self-Reported Reservations with Use of Sedation/Anesthesia Agents and Prescription Opioids for Postoperative Pain Table 1: Associations between Reservations with Fentanyl as Sedation/Anesthesia Agent and Social History