Opioid-Free Anesthesia for Patients With Joint Hypermobility Syndrome Undergoing Craneo-Cervical Fixation: A Case-series
Condition: Ehlers-Danlos Syndrome; Craniocervical Syndrome
MeSH terms: Joint Instability; Ehlers-Danlos Syndrome; Syndrome
Study type: Observational

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.
    

Detailed description: 
      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.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients between 18-60 years with diagnosis of Hypermobility Syndrome undergoing
        Craneo-cervical fixation (CCF) between Sept, 2018 to March, 2020 to get stabilized
        craneo-cervical instability (CCI), and performed under opioid-based total intravenous
        anesthesia or opioid-free total intravenous anesthesia with lidocaine, ketamine and
        dexmedetomidine (LKD).
      
Keywords: Craneocervical -instability; Craneocervical -fixation; Opioid induced hyperalgesia; Free-opioid-anesthesia; Ehlers-Danlos Syndrome; Joint Hipermobility syndrome; Central sensitization phenomena