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. 2023 Jan 27;23(1):34.
doi: 10.1186/s12871-023-01994-5.

Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial

Liang Chen  1   2 , Wensheng He  2 , Xue Liu  2 , Fahui Lv  3 , Yuanhai Li  4
Affiliations

Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial

Liang Chen et al. BMC Anesthesiol. .

Abstract

Background: Enhanced recovery after surgery (ERAS) is now widely used in various surgical fields including gynecological laparoscopic surgery, but the advantages of opioid-free anesthesia (OFA) in gynecological laparoscopic surgery under ERAS protocol are inexact.

Aims: This study aims to assess the effectiveness and feasibility of OFA technique versus traditional opioid-based anesthesia (OA) technique in gynecological laparoscopic surgery under ERAS.

Methods: Adult female patients aged 18 ~ 65 years old undergoing gynecological laparoscopic surgery were randomly divided into OFA group (Group OFA, n = 39) with esketamine and dexmedetomidine or OA group (Group OA, n = 38) with sufentanil and remifentanil. All patients adopted ERAS protocol. The primary outcome was the area under the curve (AUC) of Visual Analogue Scale (VAS) scores (AUCVAS) postoperatively. Secondary outcomes included intraoperative hemodynamic variables, awakening and orientation recovery times, number of postoperative rescue analgesia required, incidence of postoperative nausea and vomiting (PONV) and Pittsburgh Sleep Quality Index (PSQI) perioperatively.

Results: AUCVAS was (Group OFA, 16.72 ± 2.50) vs (Group OA, 15.99 ± 2.72) (p = 0.223). No difference was found in the number of rescue analgesia required (p = 0.352). There were no between-group differences in mean arterial pressure (MAP) and heart rate (HR) (p = 0.211 and 0.659, respectively) except MAP at time of surgical incision immediately [(Group OFA, 84.38 ± 11.08) vs. (Group OA, 79.00 ± 8.92), p = 0.022]. Times of awakening and orientation recovery in group OFA (14.54 ± 4.22 and 20.69 ± 4.92, respectively) were both longer than which in group OA (12.63 ± 3.59 and 18.45 ± 4.08, respectively) (p = 0.036 and 0.033, respectively). The incidence of PONV in group OFA (10.1%) was lower than that in group OA (28.9%) significantly (p = 0.027). The postoperative PSQI was lower than the preoperative one in group OFA (p = 0.013).

Conclusion: In gynecological laparoscopic surgery under ERAS protocol, OFA technique is non-inferior to OA technique in analgesic effect and intraoperative anesthesia stability. Although awakening and orientation recovery times were prolonged compared to OA, OFA had lower incidence of PONV and improved postoperative sleep quality.

Trial registration: ChiCTR2100052761, 05/11/2021.

Keywords: Analgesia; ERAS; Gynecological Laparoscopic surgery; Non-inferiority; Opioid-free anesthesia.

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Conflict of interest statement

We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

Figures

Fig. 1
Fig. 1
Flowchart based on Consolidated Standards of Reporting Trials (CONSORT) statement
Fig. 2
Fig. 2
Area under curve(AUC) of VAS scores in two groups (Group OFA, n = 39; Group OA, n = 38)
Fig. 3
Fig. 3
Visual Analogue Scale (VAS) scores from T6-T10 in two groups (Group OFA, n = 39; Group OA, n = 38)
Fig. 4
Fig. 4
Changes of mean arterial pressure (MAP) and heart rate (HR) from T1 to T5 in two groups. p < .05 is defined statistically significant. *Significant to group OFA (Group OFA, n = 39; Group OA, n = 38)
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