Effects of Opioid-based and Opioid-free Anesthesia in Patients Undergoing Elective Laparoscopic Surgeries

The aim of anesthetic management of patients undergoing surgeries should be to allow physiological changes during surgery with minimal effects on the vitals and rapid recovery from anesthesia with minimal residual effects. Since opioid-based anesthesia is associated with opioid abuse and side effects peri- and postoperatively, we conducted this study to compare the effects of opioid-free anesthesia using dexmedetomidine and ketamine with opioid-based anesthesia using fentanyl in patients undergoing elective laparoscopic surgeries.

A randomized prospective double-blinded study was undertaken on 70 adult patients undergoing elective laparoscopic surgeries. The patients were equally and randomly divided into two groups: patients in Group A were administered IV dexmedetomidine 1 µg/kg body weight and ketamine 25 mg and those in Group B were administered IV fentanyl 2 µg/kg body weight. Comparisons of parameters representing hemodynamic stability were done between the two groups, along with the depth of sedation and adverse effects, if any.

There was significantly less increase in heart rate in the dexmedetomidine group than that in the fentanyl group after intubation in intraoperative period as well as after extubation. There was an abrupt decrease in the respiratory rate (RR) at 60 th min in the patients administered fentanyl, and the difference in the fall was statistically significant compared to in those administered dexmedetomidine. In the dexmedetomidine group, there was a good stability of RR with the baseline values at all time intervals. There was a decrease in the mean arterial pressure values in both the groups, the difference being statistically insignificant. The depth of sedation was better in the patients administered dexmedetomidine according to the Ramsay Sedation Score as compared to in those administered fentanyl. The incidence of adverse effects was also lesser in the patients administered dexmedetomidine than in those administered fentanyl.

This study concluded that opioid-free anesthesia using dexmedetomidine is better than opioid-based anesthesia using fentanyl for patients undergoing elective laparoscopic surgeries due to better perioperative hemodynamic stability, deeper sedation, and lesser adverse effects postoperatively.