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Randomized Controlled Trial
. 2025 Feb 1;25(1):53.
doi: 10.1186/s12871-025-02915-4.

Opioid sparing anesthesia in patients with liver cirrhosis undergoing liver resection: a controlled randomized double-blind study

Eman Sayed Ibrahim  1   2   3 , Ahmed A Metwally  4 , Mohamed Abdullatif  5 , Essam A Eid  6 , Mahmoud G Mousa  6 , Amany A Sultan  4
Affiliations
Randomized Controlled Trial

Opioid sparing anesthesia in patients with liver cirrhosis undergoing liver resection: a controlled randomized double-blind study

Eman Sayed Ibrahim et al. BMC Anesthesiol. .

Abstract

Objective: Opioid metabolism and pharmacodynamics may be affected in hepatic patients. Ketamine and dexmedetomidine are conventional anesthetics used in our daily practice. The opioid-sparing effects of this combination have not been evaluated in patients with liver cirrhosis undergoing liver resection. We aimed to investigate the potential peri-operative opioid-sparing effects of intra-operative dexmedetomidine and ketamine infusions in patients with Child A liver cirrhosis undergoing liver resection.

Methods: This study was a randomized controlled double-blind trial. 92 adult patients of both sex with Child class (A) liver cirrhosis aged 18 to 65 years entering and completing the study. We excluded patients with renal or cardiac dysfunction or contraindications from study medications.46 patients in the opioid-sparing group (OS) receiving ketamine and dexmedetomidine infusions and 46 patients in the opioid-based (OB) group as controls. The main outcome measures: were intra-operative fentanyl requirements, postoperative fentanyl requirements, visual analogue pain scores, postoperative nausea, vomiting, ileus, desaturation, intra-operative hemodynamic events, and ICU stay were recorded.

Results: The total intra-operative fentanyl consumption was significantly lower in the OS group compared with the OB group, 183.2 ± 35.61 µg and 313.5 ± 75.06 µg, respectively, P < 0.001. The postoperative 1st 48 h fentanyl consumption was significantly lower in the OS group compared with the OB group, 354.5 ± 112.62 µg and 779.1 ± 294.97 ± µg, respectively, P < 0.001. Visual analogue scores were significantly better in the OS group at the early 2-hour assessment point postoperatively. The postoperative adverse events were significantly more frequent in the opioid-based group. ICU stay was significantly shorter in the OS group.

Conclusions: Administering dexmedetomidine and ketamine infusions intra-operatively to patients with Child A liver cirrhosis undergoing liver resection resulted in notable opioid-sparing effects, with reductions of approximately 40% intra-operatively and 55% postoperatively. The opioid-sparing group exhibited improved postoperative outcomes, including reduced pain, decreased incidence of opioid-related side effects and shorter ICU stays.

Keywords: Liver cirrhosis; Liver resection; OSA.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval for this study (Ethical Committee N° 00309/2022) was provided by the Institutional Review Board of the National Liver Institute, Written informed consent was obtained from all participants. Consent for publication: Not applicable. Clinical registration: The study was registered in the ClinicalTrials.gov identifier number: NCT05674877. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram showing patients allocation at different stages of the study. Mets, metastasis
See this image and copyright information in PMC

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