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Randomized Controlled Trial
. 2025 Feb 8;25(1):62.
doi: 10.1186/s12871-025-02938-x.

Effects of balanced opioid-free anesthesia on post-operative nausea and vomiting in patients undergoing video-assisted thoracic surgery: a randomized trial

Xiang Yan #  1 , Chen Liang #  2 , Jia Jiang  1 , Ying Ji  3 , An-Shi Wu  4 , Chang-Wei Wei  5
Affiliations
Randomized Controlled Trial

Effects of balanced opioid-free anesthesia on post-operative nausea and vomiting in patients undergoing video-assisted thoracic surgery: a randomized trial

Xiang Yan et al. BMC Anesthesiol. .

Abstract

Objectives: Postoperative nausea and vomiting (PONV) is common after video-assisted thoracic surgery, which may be associated with the use of intraoperative opioids. We tested the hypothesis that balanced opioid-free anesthesia (OFA) might reduce the incidence of PONV after video-assisted thoracic surgery.

Methods: One hundred and sixty-eight adults undergoing video-assisted thoracic assisted surgery were randomly assigned to receive balanced opioid-free anesthesia or balanced opioid-based anesthesia (OBA). The primary outcome was the incidence of PONV, which was assessed with the Myles's simplified PONV impact scale during the initial 24 h after surgery.

Results: Compared with OBA group, the overall incidence of PONV in OFA group was significant reduced (14.6% vs. 30.1%, P = 0.017), and OFA reduced the risk of PONV events within 24 h of surgery (HR, 0.44; 95%CI: 0.22-0.87, P = 0.018). The incidence of other postoperative complications in OFA group was lower than that in OBA group (19.5% vs. 33.7%, P = 0.039). The quality of recovery, distance of 6-minute walk test, pain scores, and 36-item short form survey were comparable at each time points.

Conclusion: In patients undergoing video-assisted thoracic surgery, the use of balanced OFA anesthesia can help reduce the incidence of PONV events. This anesthetic regimen has shown good feasibility without significantly increasing the patient's pain score and complications.

Clinical trial registration number: Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022.

Keywords: 6-min walk test; Anesthesia; Nausea and vomiting; Opioid; Quality of recovery; Video-assisted thoracic surgery.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was reviewed by the institutional ethics committee. IRB number: 2022-ke-19, Date of approval: Feb 7, 2022. All included subjects in this study signed written informed consent before study inclusion. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart. ASA, American Society of Anesthesiologists
Fig. 2
Fig. 2
Distribution of PONV severity score during 24h after surgery. PONV, postoperative nausea and vomiting. OFA, opioid-free anesthesia. OBA, opioid-based anesthesia
Fig. 3
Fig. 3
The Kaplan-Meier curve of time to first postoperative nausea and vomiting. OBA, opioid-based anesthesia; OFA, opioid-free anesthesia
See this image and copyright information in PMC

References

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