Impact of Opioid-Free Anesthesia on Postoperative Quality of Recovery in Patients After Laparoscopic Cholecystectomy-A Randomized Controlled Trial

Abstract

Purpose Opioid analgesics may delay discharge and affect postoperative quality of recovery because of their significant adverse effects, such as hyperalgesia, postoperative nausea and vomiting (PONV), shivering and urine retention. We aimed to compare the quality of postoperative recovery (QoR) between patients undergoing laparoscopic cholecystectomy surgeries with opioid-free anesthesia (OFA) and those with opioid-based anesthesia (OA). Patients and Methods 80 adult patients undergoing laparoscopic cholecystectomy were randomly allocated to an opioid-free anesthesia group (Group OFA) or an opioid-based anesthesia group (Group OA). The primary outcome was the quality of postoperative recovery using QoR-15 scale on postoperative day 1 (POD 1) and 2 (POD 2). The secondary outcomes included the incidence of opioid-related adverse symptoms, perioperative hemodynamic data, duration of post-anesthesia care unit (PACU) stay and duration of extubation, and the incidences of hypotension and bradycardia. Results A statistically significant difference in total QoR-15 was observed between the two groups on POD 1 and POD 2 (91.00 (90.00, 92.00) vs 113.00 (108.25, 115.00), 106.00 (104.00, 112.00) vs 133.00 (130.00, 135.00), P < 0.001). The incidence of opioid-related symptoms was significantly different between the two groups on POD 1 ( P < 0.05). There were between-group differences in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T3 ( P < 0.001). There was also a significant difference in the incidence of hypotension between the two groups ( P = 0.001). However, there were no significant differences in the duration of PACU stay, duration of extubation and the incidence of bradycardia ( P > 0.05). There was no difference in heart rate between the two groups at all observed time points, either ( P > 0.05). Conclusion We concluded that the quality of recovery of patients receiving OFA was superior to those receiving OA after laparoscopic cholecystectomy.

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

“…Laparoscopic surgery necessitates swift anesthesia induction, precise anesthesia depth control, and steady intraoperative hemodynamics. Additionally, it demands prompt postoperative recovery devoid of complications like respiratory depression, nausea, and vomiting ( 20 , 21 ). This study explores the use of dual short-acting anesthetics in TIVA and CIVIA protocols to assess if the selection of anesthetic agents and methods influences the risk of delayed neurocognitive recovery or postoperative cognitive dysfunction.…”

Surgeons’ knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons

“…As research efforts continue to focus on how best to treat patients’ perioperative pain, including those with OUD, the concept of “opiate free anesthesia” (OFA) is emerging as a method to decrease the use of opioids [ 29 ]. By using a multimodal nonopioid approach to anesthesia and perioperative analgesia, patients are able to avoid opioids altogether with either similar or improved outcomes compared to standard opioid analgesia [ 30 – 32 ]. A meta-analysis by D’Amico and colleagues examined the use of OFA in thoracic surgery and concluded that it was associated with lower rates of complications, lower pain scales and lower morphine consumption postoperatively [ 33 ].…”