Opioid-Free Anesthesia and the Nurse Anesthetist. Experiences in Sweden and the United States.

Abstract

Background: Opioid addiction and overdose deaths are growing problems in both Sweden and the United States. Opioids have played a major role in anesthesia since the 1960s, but cause numerous negative effects which are associated with patient suffering and increased cost of care. Evidence shows opioid-free anesthesia is emerging as a safe alternative, reducing the negative effects of opioids. Research on the nurse anesthetists’ experiences of opioid-free anesthesia is limited. Aim: The aim of this study was to compare experiences among nurse anesthetists in Sweden and the United States with regards to their familiarity with opioid-free anesthesia, its perioperative risks and benefits, and the perceived connection between intraoperative opioids and postoperative addiction. Methods: A web-based survey was distributed to nurse anesthetists in Sweden and the United States. Data was analyzed using SPSS Statistics and presented descriptively, allowing comparisons between Sweden and the United States by displaying the data from the two nations in the same charts. Results: The nurse anesthetists from the United States had more experience with opioid-free anesthesia than the nurse anesthetists from Sweden. The majority of the nurse anesthetists from the United States agreed to all the benefits and disagreed to all the risks of opioid-free anesthesia listed in the survey. Many of the Swedish nurse anesthetists did not know the specific benefits and risks, nor which drugs should be included in an opioid-free anesthesia regime of care. Opioid addiction was perceived as a major problem in society by nurse anesthetists from both nations. Conclusion: American nurse anesthetists have more clinical experience and theoretical knowledge of opioid-free anesthesia compared to Swedish nurse anesthetists. More education is needed in Sweden to safely implement the concept. This study suggests that opioid-free anesthesia would be beneficial to Swedish nurse anesthetists’ nursing priorities and postoperative patient outcome.