Friedberg's Triad (Measure the brain, Preempt the pain, Emetic drugs abstain) is the pathway to opioid free anesthesia (OFA). OFA eliminates one pathway to postoperative opioid addiction. OFA eliminates opioid related adverse drug effects (ORADES). ORADES include postoperative nausea & vomiting (PONV), respiratory depression, obstruction, aspiration, sedation, prolonged emergence, brain fog, ileus, urinary retention. Consequences with only one ORADE? 55% increased length of stay, 47% increased costs, 36% increased 30-day admission risk, & 3.4X mortality risk. Opioiinclusive anesthesia fails to prevent postop pain but increases PONV!
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