The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial

Abstract

Purpose Opioid-free anesthesia (OFA) is an emerging technique that eliminates intraoperative use of opioids and is associated with lower postoperative opioid consumption and reduced adverse postoperative events. The present study investigated the effect of OFA on the quality of recovery in patients undergoing gynecological laparoscopy. Patients and Methods Seventy-five adult patients undergoing elective gynecological laparoscopy were randomly assigned to the OFA group with dexmedetomidine and lidocaine or the remifentanil-based anesthesia (RA) group with remifentanil. Patients, surgeons, and medical staff members providing postoperative care and assessing outcomes were blinded to group allocation. The anesthesiologist performing general anesthesia could not be blinded due to the different drug administration protocols by groups. The primary outcome was the quality of recovery measured using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes were postoperative pain score, intraoperative and postoperative adverse events, and stress hormones levels. Results The patients in both groups had comparable baseline characteristics. The QoR-40 score on postoperative day 1 was significantly higher in the OFA group than in the RA group (155.9 ± 21.2 in the RA group vs 166.9 ± 17.8 in the OFA group; mean difference: −11.0, 95% confidence interval: −20.0, −2.0; p = 0.018). The visual analog scale score at 30 min after surgery was significantly lower in the OFA group than in the RA group (6.3 ± 2.3 in the RA group vs 4.1 ± 2.1 in the OFA group; p < 0.001). The incidences of nausea and shivering in the post-anesthetic care unit were also significantly lower in the OFA group ( p = 0.014 and 0.025; respectively). Epinephrine levels were significantly lower in the OFA group ( p = 0.002). Conclusion OFA significantly improved the quality of recovery in patients undergoing gynecological laparoscopy.

The efficacy and safety of an adapted opioid-free anesthesia regimen versus conventional general anesthesia in gynecological surgery for low-resource settings: a randomized pilot study

“…The result of this central stimulation during the perioperative period leads to PONV, more common in major gynecological surgery, where PONV occurs at incidences of 50—80% [ 22 , 23 ]. Hence, similar to previous studies on gynecology surgery [ 28 – 30 , 36 – 38 , 40 , 41 ] the frequency of episodes of PONV was reduced in the OFA group ( p = 0.0137).…”

“…We found this adapted OFA protocol had a 100% success rate with significant lesser consumption of isoflurane, no significant intraoperative complication and better intraoperative hemodynamic stability in the OFA group. These findings re-iterate previous reports from other clinical trials on gynecological surgery [26,[28][29][30][31][35][36][37][38][39][40][41] demonstrating a 100% success rate for OFA with stable or better hemodynamics and no intra-operative complications. By contrast, a multicentre French clinical trial on 314 non-cardiac surgeries (with 5.7% gynecological surgical procedures) reported more hypertension, hypotension and severe bradycardia (less than 45 beats/min) during OFA which prompted the early termination of the clinical trial [25].…”

“…This was an expected finding that has been correlated with the pharmacodynamic properties of opioids on the intestines: a reduction of peristaltic movements [ 8 ]. Similar to other authors working on both abdominal and laparoscopic gynecological surgery [ 29 , 30 , 37 , 38 ] as well as mastectomy [ 28 , 31 ] patients in the OFA group demonstrated statistically significant quicker postoperative mobilization or recovery with better postoperative satisfaction assessed on either the QoR-40 questionnaire or verbal rating scale for satisfaction. This reinforces evidence of OFA as being safe and effective for gynecological surgery.…”

“…Moreover, this profound bradycardia occurred at a high dose of dexmedetomidine at 0.4 – 1.4 ug/kg/h which more than doubled dexmedetomidine doses of 0.2– 0. 6ug/kg/h [ 30 , 35 , 37 , 38 ] used by other clinical trials on gynecology surgery where stable hemodynamics were observed. Although dexmedetomidine is the reference OFA drug due to its α2-adrenergic analgesic-sedative-hypnotic-sympatholytic properties, its worldwide use is limited by its availability and relatively high financial cost.…”

“…By applying this eligibility criterion, the study population retained without any intentional selection bias were relatively young (mean age: 40.3 ± 10.7 years) and healthy patients without pulmonary pathologies, precluding the assessment of the aforementioned potential advantages of OFA. Several authors [ 29 , 30 , 38 ] working on OFA in gynecological surgery equally had a relatively young healthy ASA I and II study population as ours. Thirdly, the randomization of patients was more of a pragmatic approach, hence, might have flawed the study findings with allocation bias.…”