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Randomized Controlled Trial
. 2025 Jul 9;29(1):225.
doi: 10.1007/s10029-025-03410-y.

Opioid-free versus opioid-based anesthesia for day surgery laparoscopic inguinal hernia repair under ERAS protocol: a randomized non-inferiority trial

Chun Wang #  1 , Peng Shi #  1 , Jun Xu #  2 , Xiaohua Fan  1 , Jinjun Bian  1 , Lulong Bo  3
Affiliations
Randomized Controlled Trial

Opioid-free versus opioid-based anesthesia for day surgery laparoscopic inguinal hernia repair under ERAS protocol: a randomized non-inferiority trial

Chun Wang et al. Hernia. .

Abstract

Purpose: Laparoscopic inguinal hernia repair (LIHR) is increasingly performed as a day surgery procedure under enhanced recovery after surgery (ERAS) protocol. While opioid-based anesthesia (OA) remains standard, its adverse effects may impair postoperative recovery. This randomized controlled non-inferiority trial assessed whether opioid-free anesthesia (OFA) provides non-inferior postoperative pain control to OA for day surgery LIHR under ERAS protocol and evaluated comprehensive recovery outcomes.

Methods: This single-center, prospective, randomized non-inferiority trial enrolled 90 patients scheduled for day surgery LIHR who were randomly allocated to receive either lidocaine-dexmedetomidine-based OFA (n = 45) or sufentanil-remifentanil-based OA (n = 45). The primary outcome was postoperative 24-h time-weighted average visual analog scale (TWA-VAS) pain score at rest. Secondary outcomes included extended pain assessment, quality of recovery indicators, day surgery pathway efficiency, and perioperative hemodynamic stability.

Results: The 24-h TWA-VAS scores were 1.84 ± 1.02 in the OFA group and 1.77 ± 0.88 in the OA group (mean difference: 0.07; 95% CI: -0.33-0.47), establishing non-inferiority. The OFA group experienced significantly lower rates of intraoperative hypotension (8.9% vs. 53.3%; relative risk: 0.17; P = 0.001) but longer laryngeal mask airway removal time (20 vs. 15 min; P = 0.034) and post-anesthesia care unit stay (50 vs. 45 min; P = 0.018). No significant differences were observed in Quality of Recovery-15 scores, rescue analgesia requirements, postoperative urinary retention (POUR), postoperative nausea and vomiting (PONV), or 24-h discharge success rates.

Conclusion: Under ERAS protocol, lidocaine-dexmedetomidine-based OFA provided non-inferior analgesic efficacy to OA for day surgery LIHR, while delivering superior hemodynamic stability. Despite modestly prolonged emergence times, OFA maintained comparable recovery quality and discharge success rates. These findings establish OFA as a valuable alternative anesthetic strategy for day surgery LIHR under ERAS protocol, particularly for patients at risk of opioid-related adverse effects.

Trial registration: ChiCTR2500098054, registered on February 28, 2025, retrospectively registered.

Keywords: Day surgery; Enhanced recovery; Inguinal hernia; Multimodal analgesia; Opioid-free anesthesia.

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Conflict of interest statement

Declarations. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of The First Affiliated Hospital of Naval Medical University (No. CHEC2023-194) on August 3, 2023. Consent to participate: Written informed consent was obtained from all individual participants included in the study. Consent to publish: Not applicable as no identifying information of participants is included in this article. Competing interests: All authors declare that they have no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

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References

    1. HerniaSurg Group (2018) International guidelines for groin hernia management. Hernia 22:1–165. https://doi.org/10.1007/s10029-017-1668-x - DOI
    1. Zhong Y, He M, Liu Z et al (2023) Efficacy of laparoscopic inguinal hernia in day surgery mode and inpatient surgery mode in china: A meta-analysis. Med (Baltim) 102:e32998–e32998. https://doi.org/10.1097/md.0000000000032998 - DOI
    1. Cukierman DS, Cata JP, Gan TJ (2023) Enhanced recovery protocols for ambulatory surgery. Best Pract Res Clin Anaesthesiol 37:285–303. https://doi.org/10.1016/j.bpa.2023.04.007 - DOI
    1. Liu J, Zhang H, Qiao X et al (2023) The feasibility and safety of laparoscopic inguinal hernia repair as a 24-h day surgery for patients aged 80 years and older: a retrospective cohort study. Hernia 27:1533–1541. https://doi.org/10.1007/s10029-023-02912-x - DOI
    1. Paul AK, Smith CM, Rahmatullah M et al (2021) Opioid analgesia and Opioid-Induced adverse effects: A review. Pharmaceuticals 14:1091–1091. https://doi.org/10.3390/ph14111091 - DOI

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