Opioid-Free Anesthesia for Pain Relief After Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial

Area of Science:

• Anesthesiology
• Surgical Innovation
• Pain Management

Background:

• Opioid-based anesthesia (OBA) is standard for laparoscopic cholecystectomy (LC), but carries risks of side effects and dependence.
• Opioid-free anesthesia (OFA) presents an alternative aiming to mitigate opioid-related complications.
• Comparing OFA and OBA is crucial for optimizing anesthetic protocols in LC.

Purpose of the Study:

• To compare the efficacy of OFA versus OBA in patients undergoing LC.
• To evaluate postoperative analgesic requirements, recovery times, and patient comfort.

Main Methods:

• 150 patients undergoing 3-port LC were randomized to OFA (esketamine, dexmedetomidine, lidocaine) or OBA (remifentanil).
• Both groups received local anesthetic infiltration.
• Primary outcome: rescue analgesic consumption within 24 hours; secondary outcomes: recovery metrics, pain scores, PONV, and satisfaction.

Main Results:

• OFA group showed significantly lower rescue analgesic consumption (P < 0.001) and faster time to first flatus (P = 0.029).
• OFA group experienced significantly longer LMA removal time (P < 0.001) and orientation recovery (P < 0.001).
• Lower VAS pain scores at 2 and 8 hours (P = 0.002, P = 0.001) and lower heart rate at LMA insertion (P = 0.016) were observed in the OFA group.

Conclusions:

• OFA may reduce postoperative analgesic needs and pain intensity in LC.
• OFA can potentially shorten the time to first flatus.
• While OFA offers benefits in pain control, longer recovery times for LMA removal and orientation need consideration.