Surgical caffeine does not reduce early postoperative opioid
Intraoperative caffeine is unlikely to reduce postoperative opioid consumption, according to a recent study in the journal Anesthesia & Analgesia. However, caffeine was well-tolerated during anesthetic emergence.

This trial tested the hypothesis that intraoperative caffeine would reduce postoperative opioid consumption. The secondary objective was to assess whether caffeine improves neuropsychological recovery postoperatively.

Adult (?18 years old) surgical patients (n = 65) presenting for laparoscopic colorectal and gastrointestinal surgery were randomized to an intravenous caffeine citrate infusion (200 mg) or dextrose 5% in water (40 mL) during surgical closure. The primary outcome was cumulative opioid consumption through postoperative day 3. Secondary outcomes included subjective pain reporting, observer-reported pain, delirium, Trail Making Test performance, depression, and anxiety screens, and affect scores. Adverse events were reported, and hemodynamic profiles were also compared between the groups.

- The median cumulative opioid consumption was 77 mg for caffeine and 51 mg for placebo.

- After post hoc adjustment for baseline imbalances, caffeine was associated with increased opioid consumption.

- There were otherwise no differences in prespecified pain or neuropsychological outcomes between the groups.

- No major adverse events were reported in relation to caffeine, and no major hemodynamic perturbations were observed with caffeine administration.

Caffeine appears unlikely to reduce early postoperative opioid consumption. Caffeine otherwise appears well-tolerated during anesthetic emergence.