opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series

Conditions: Ehlers-Danlos Syndrome; Craniocervical Syndrome

Summary: cranio-cervical instability (cci) has been well identified in diseases regarding connective tissue, such as ehlers-danlos syndrome/hipermobility type (eds-ht). these patients frequently suffer from severe widespread pain with very difficult management and control. chronic neuroinflamation, opioid-induced hyperalgesia, and central sensitization phenomena may explain this complex painful condition. a retrospective, observational, consecutive case series study is designed to determine if opioid-free anesthetic management shows a reduction in postoperative pain and opioid rescues needs in comparison with opioid-based anesthesia management for patients with eds-ht undergoing crano-cervical fixation.

cranio-cervical instability (cci) has been well identified in diseases regarding connective tissue, such as ehlers-danlos syndrome/hipermobility type (eds-ht). these patients frequently suffer from severe widespread pain with very difficult management and control. chronic neuroinflamation, opioid-induced hyperalgesia, and central sensitization phenomena may explain this complex painful condition. a retrospective, observational, consecutive case series study is designed to determine if opioid-free anesthetic management shows a reduction in postoperative pain and opioid rescues needs in comparison with opioid-based anesthesia management for patients with eds-ht undergoing craneo-cervical fixation. main aim: to determine if the administration of opioid-free anesthesia with propofol, lidocaine, ketamine, and dexmedetomidine shows reduction of postoperative pain, and postoperative needs of opioids rescue in patients undergoing ccf. secondary aims: * to determine if the administration of opioid-free anesthesia in patients undergoing ccf, and postoperative lidocaine, ketamine, and dexmedetomidine infusions can reduce the preoperative needs of opioids treatment at discharge time. * to determine if the administration of opioid-free anesthesia in patients undergoing ccf reduces the postoperative gastrointestinal complications. * to determine if the administration of postoperative lidocaine, ketamine, and dexmedetomidine infusions in patients underwent ccf can reduce the preoperative needs of postoperative anxiolytic treatment.

Eligibility criteria:
inclusion criteria: * patients with a diagnosis of hypermobility syndrome undergoing craneo-cervical fixation (ccf) * patients between 18-60 years. * patients enrolled in ccf surgery between september 2018 to march 2020 to get stabilized craneo-cervical instability (cci). * patients under opioid-based total intravenous anesthesia or opioid-free total intravenous anesthesia with lidocaine, ketamine and dexmedetomidine (lkd). exclusion criteria: * ccf to stabilized post-traumatic or oncologic cci. * lidocaine allergy. * advances heart-block. * epilepsy or convulsive syndrome non-medicated.

Keywords: craneocervical -instability craneocervical -fixation opioid induced hyperalgesia free-opioid-anesthesia ehlers-danlos syndrome joint hipermobility syndrome central sensitization phenomena