Opioid-free anaesthesia improves outcomes in gynaecological laparoscopic surgery

A new study published in BMC Anesthesiology suggests that The opioid-free anesthesia (OFA) approach is comparable to the opioid-based anaesthesia (OA) technique in terms of analgesic impact and intraoperative anaesthetic stability in gynaecological laparoscopic surgery under the enhanced recovery after surgery (ERAS) protocol. 

The benefits of opioid-free anaesthesia in gynaecological laparoscopic surgery under the ERAS protocol are not entirely clear, but they are now often utilised in a variety of surgical specialties, including gynaecological surgery. In order to compare the efficacy and viability of the OFA approach with the conventional OA technique in gynaecological laparoscopic surgery under ERAS, Liang Chen and colleagues carried out this study.

During gynaecological laparoscopic surgery, adult female patients aged 18 to 65 were randomly assigned to either the OFA group (Group OFA, n = 39) with esketamine and dexmedetomidine or the OA group (Group OA, n = 38) with sufentanil and remifentanil. Every patient followed the ERAS protocol. Area under the curve (AUC) of Visual Analogue Scale (VAS) scores (AUCVAS) postoperatively was the main result. The Pittsburgh Sleep Quality Index (PSQI) perioperatively, intraoperative hemodynamic variables, awakening and orientation recovery times, number of postoperative rescue analgesia needed, incidence of postoperative nausea and vomiting (PONV), and awakening and orientation recovery times were all considered secondary outcomes. 

Key findings of the study were:

1. AUCVAS was (16.72 2.50 for Group OFA vs. 15.99 2.72 for Group OA). The quantity of rescue analgesia needed did not change. 

2. Except for MAP at the time of surgical incision immediately, there were no between-group variations in mean artery pressure (MAP) or heart rate (HR). 

3. Times of awakening and recovery from orientation were both longer in group OFA than in group OA. 

4. In group OFA, the incidence of PONV (10.1%) was substantially lower than that of group OA (28.9%) (p = 0.027). 

5. In group OFA, the postoperative PSQI was less than the preoperative PSQI.

In conclusion, despite taking longer than OA to recover from awakening and orientation, OFA had a lower chance of PONV and better postoperative sleep quality.

Reference: 

Chen, L., He, W., Liu, X., Lv, F., & Li, Y. (2023). Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial. In BMC Anesthesiology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12871-023-01994-5