Opioid-Free versus Opioid-Based Anesthesia for Quality of Recovery After Knee Arthroscopy: A Randomized Non-Inferiority Trial
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Lvdan Huang1, Yu Lan2, Wangao Li2
1Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Purpose:
We determined whether dexmedetomidine- and esketamine-based opioid-free anesthesia (OFA) was non-inferior to opioid-based anesthesia (OA) for 24-hour Quality of Recovery-15 (QoR-15) after elective knee arthroscopy with femoral nerve block.
Patients And Methods:
In this patient- and assessor-blinded randomized trial, 70 adults undergoing knee arthroscopy with femoral nerve block were allocated to OFA or OA. The primary outcome was 24-hour QoR-15 (non-inferiority margin, -6 points). Secondary outcomes included pain, rescue analgesia, and adverse events. The primary modified intention-to-treat (mITT) analysis included 66 randomized participants with an assessable 24-hour QoR-15 score (33 per group).
Results:
Mean 24-hour QoR-15 scores were 126.7 ± 6.4 with OFA and 125.3 ± 6.1 with OA (mean difference 1.45, 95% confidence interval [CI] -1.60 to 4.51), establishing non-inferiority but not superiority. OFA increased rescue opioid requirements (Hodges-Lehmann estimate 10 mg oral morphine equivalents, 95% CI 0 to 10; p=0.037), shortened time to rescue analgesia (hazard ratio 2.11, 95% CI 1.14 to 3.92; p=0.018), and increased early pain. OFA reduced postoperative nausea and vomiting (21.2% vs 48.5%; relative risk 0.44, 95% CI 0.21 to 0.92; p=0.038). Two postoperative bradycardia events occurred with OFA.
Conclusion:
In adults undergoing elective knee arthroscopy with femoral nerve block, dexmedetomidine- and esketamine-based OFA was non-inferior to OA for 24-hour QoR-15. OFA was associated with lower postoperative nausea and vomiting, but higher early pain and an earlier need for rescue analgesia.
Trial Registration:
Chinese Clinical Trial Registry, ChiCTR2400084207; registered 13 May 2024, before enrollment. URL: https://www.chictr.org.cn/showproj.html?proj=230255.
