Opioid-Free Anaesthesia as good as Opioid Based Anaesthesia in Patients Undergoing Laparotomy For Gynaecological Malignancy: Study

Recent study aimed to compare the outcomes of opioid-free anesthesia (OFA) and opioid-based anesthesia (OBA) with ultrasound-guided rectus sheath block (RSB) in female patients undergoing laparotomy for gynecological malignancy. This double-blind randomized controlled trial included fifty female patients undergoing elective gynecological laparotomy under general anesthesia, randomized into OFA and OBA groups. Both groups received RSB, with Group OBA receiving IV fentanyl and Group OFA receiving IV dexmedetomidine and ketamine. The primary outcome was the time to reach post-anesthesia care unit (PACU) discharge criteria, with secondary outcomes including time to eye-opening, extubation, shift to PACU, visual analog scale (VAS) pain scores, time to first rescue analgesia, 24-hour morphine consumption, and postoperative nausea/vomiting (PONV) till 24 hours.

Outcome Analysis

The study found that the time to attain PACU discharge criteria was similar between the groups, but time to extubation and shift to PACU was longer in Group OFA. However, secondary outcomes such as postoperative pain, time to first rescue analgesia, total morphine consumption, and PONV were comparable between the groups. The OFA group demonstrated comparable postoperative analgesia and time to PACU discharge criteria in adult patients undergoing open gynecological oncological surgery under general anesthesia.

Support for Opioid-Free Anesthesia

The study supported the use of OFA as an effective anesthesia technique in gynecological malignancy surgeries, providing insights into improved recovery times with opioid-free approaches. The inclusion of RSB in both groups highlighted the importance of multimodal analgesia in enhancing postoperative outcomes. Despite some limitations related to surgical heterogeneity and delayed recovery due to catheter issues, the findings contribute to the understanding of OFA benefits in complex surgeries and the potential for further research on its long-term advantages and additional analgesic strategies.

Conclusion

In conclusion, the study demonstrated that OFA with dexmedetomidine, ketamine, and RSB can achieve comparable postoperative results in patients undergoing gynecological oncological surgery under general anesthesia. The research provides valuable insights into optimizing anesthesia techniques for improved postoperative recovery and pain management in female patients undergoing laparotomy for gynecological malignancy.

Key Points

- A double-blind randomized controlled trial compared opioid-free anesthesia (OFA) with opioid-based anesthesia (OBA) in female patients undergoing laparotomy for gynecological malignancy, utilizing ultrasound-guided rectus sheath block (RSB). Fifty patients were divided into OFA and OBA groups, both receiving RSB, with OBA group receiving IV fentanyl and OFA group receiving IV dexmedetomidine and ketamine.

- Primary outcome was time to achieve post-anesthesia care unit (PACU) discharge criteria, with secondary outcomes including time to eye-opening, extubation, shift to PACU, visual analog scale (VAS) pain scores, time to first rescue analgesia, 24-hour morphine consumption, and postoperative nausea/vomiting (PONV) till 24 hours.

- Time to attain PACU discharge criteria was similar between groups, but time to extubation and shift to PACU was longer in the OFA group. Postoperative pain, time to first rescue analgesia, morphine consumption, and PONV were comparable between groups, showing OFA's effectiveness in providing postoperative analgesia.

- Study supports OFA as an effective anesthesia technique in gynecological malignancy surgeries, highlighting the benefits of opioid-free approaches in improving recovery times. Both groups received RSB, emphasizing multimodal analgesia for better postoperative outcomes, despite some limitations due to surgical heterogeneity and catheter-related issues.

- The research contributes to understanding the benefits of OFA in complex surgeries and suggests further exploration of long-term advantages and additional analgesic strategies.

- In conclusion, OFA with dexmedetomidine, ketamine, and RSB showed comparable postoperative results in female patients undergoing laparotomy for gynecological malignancy, providing insights into optimizing anesthesia techniques for enhanced postoperative recovery and pain management.

Reference –

Reshma Kalagara et al. (2025). Comparison Between Opioid-Based Anaesthesia Technique And Opioid-Free Anaesthesia Technique In Patients Undergoing Laparotomy For Gynaecological Malignancy: A Randomised Controlled Trial. *Indian Journal Of Anaesthesia*. https://doi.org/10.4103/ija.ija_151_24.