Opioid-Free versus Opioid-Sparing Anesthesia for Postoperative Pain and Early Recovery After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Abstract

Purpose: Enhanced recovery after surgery emphasizes effective analgesia while minimal opioid use. Opioid-free anesthesia (OFA) and opioid-sparing anesthesia (OSA) have been shown to enhance recovery by reducing opioid-induced side effects. This study compared the efficacy of OFA and OSA in managing postoperative pain and recovery after laparoscopic cholecystectomy (LC).

Patients and methods: A single-center, randomized controlled trial was conducted with 86 adults undergoing LC. Patients received either OSA (sufentanil/remifentanil) or OFA (no opioids). Both groups received propofol, esketamine, dexmedetomidine, and erector spinae plane block. The primary outcome was pain area under the curve (AUCVAS) within 36 hours postsurgery. Secondary outcomes included hemodynamics, recovery times and bowel function.

Results: Eighty-one patients (41 and 40 in the OFA and OSA groups, respectively) completed the study. The AUCVAS scores were similar between the OFA (7.3 ± 1.4) and OSA (6.9 ± 1.3) groups (P = 0.201), the difference in AUCVAS between the two groups was 0.384 (95% CI: -0.296, 1.064), which was significantly below the preset noninferiority threshold of 1.0, demonstrating the noninferiority of OFA. While early pain scores within the first 12 hours postanesthesia care unit (PACU) discharge were slightly higher in the OFA group, but overall pain control was sufficient in both groups. The VAS scores from PACU discharge to 36 hours postoperatively, intraoperative hemodynamic variables, and the need for rescue analgesia were comparable. OFA patients experienced a faster bowel recovery (13.8 ± 2.4 vs 15.5 ± 2.3 hours, P = 0.002). Recovery times, postoperative QoR-40 scores, and patient satisfaction were similar between the groups.

Conclusion: OFA is noninferior to OSA in pain management and hemodynamic stability, with faster bowel recovery after LC.

Keywords: laparoscopic cholecystectomy; opioid-free anesthesia; opioid-sparing anesthesia; postoperative pain; randomized controlled trial.

Figure 1

CONSORT patient enrolment diagram.

Figure 2

Area under curve (AUC) of Visual Analogue Scale (VAS) scores comparison between two groups (A) and at different time points after PACU discharge (B) (Group OFA, n=41; Group OSA, n=40).

Figure 3

Postoperative Visual Analogue Scale (VAS) scores (A), changes in mean arterial pressure (MAP) (B) and heart rate (C) at each time point in perioperative period in groups OFA and OSA. T0: before anesthesia induction, T1: after anesthesia induction, T2: at tracheal intubation, T3: after nerve block, T4: in skin incision, T5: 1 minute after pneumoperitoneum, T6: 30 minutes after pneumoperitoneum, T7: at the end of surgery.