Effect of opioid-free anesthesia on postoperative recovery in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial.
Opioid-free anesthesia raised recovery scores by 4 points, below meaningful clinical benefit
Effect of opioid-free anesthesia on postoperative recovery in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial.
Opioid-free anesthesia (opioid-free anesthesia) has been proposed to reduce opioid-related adverse effects, although its impact on overall postoperative recovery remains uncertain.
In this single-center randomized controlled trial, 200 patients aged ≥60 years undergoing elective laparoscopic abdominal surgery were randomized to receive either opioid-free anesthesia (dexmedetomidine, esketamine, and lidocaine) or conventional OA.
extra recovery points fell short of a meaningful benefit
A total of 195 patients completed the study (opioid-free anesthesia, n = 98; OA, n = 97).
However, the observed difference was below the prespecified threshold for clinical significance and was no longer present at 48 or 72 h.
Opioid-free anesthesia reduced the incidence of postoperative nausea and vomiting during the first 72 postoperative hours and modestly reduced postoperative opioid consumption.
Although chronic postsurgical pain at 3 months was less frequent in the opioid-free anesthesia group, this secondary finding should be considered exploratory.
In elderly patients undergoing laparoscopic abdominal surgery, opioid-free anesthesia reduced postoperative nausea and vomiting and modestly accelerated gastrointestinal recovery.
However, it did not result in a clinically meaningful improvement in overall postoperative recovery as measured by the QoR-15 and was associated with delayed emergence, prolonged PACU stay, and more frequent intraoperative hypertension.