Opioid free versus opioid based anesthesia in abdominal gynecological surgery: a prospective randomized controlled trial
Abstract
Background & objective: Opioids have been in use by the anesthesiologists in almost all major surgical cases since ages, but these are not without side effects. During the recent past, opioid free anesthesia–a wonderful technique, has gained rapid popularity as it saves the patient from the side effects. Many drugs and drug combinations have been advocated. Ketamine–lidocaine combination produces central desensitization of the pain pathways, and an anti-inflammatory and anti-hyperalgesic effect in a synergistic manner. We compared opioid free versus opioid based anesthesia in abdominal gynecological surgery regarding analgesic efficacy and the side effects.
Methodology: After trial registration (PACTR202007844671903), 68 patients enrolled in this study were divided into two groups (34 each) according to the analgesics used. Under GA, Group O received loading dose of fentanyl 1 µg/kg followed by infusion at a rate of 1 μg/kg/h. Group OF received ketamine 0.5 mg/kg as a bolus, a loading dose of lidocaine 1.5 mg/kg followed by infusion 1.5 mg/kg/h. The primary outcome objective was postoperative pain assessed for 24 h using VAS score.
Results: The VAS score was significantly lower in Group OF during the first 4 postoperative hours; at immediate postoperative time–VAS0 (p 0.001), after one hour–VAS1 (p 0.001), 2h after–VAS2 (p = 0.001), and 4 h after–VAS4 (p = 0.001). Also, Group OF showed significantly lower recovery time (p = 0.001), higher RASS score (p = 0.001), less rescue analgesic consumption, no bowel dysfunction with stable peri-operative hemodynamics.
Conclusion: Opioid free anesthesia is a promising technique, using ketamine–lidocaine combination in abdominal gynecological surgeries enhanced patients recovery with better analgesia profile and stable hemodynamics.
Abbreviations: HR–heart rate; MABP–mean arterial blood pressure; NIBP–non–invasive blood pressure; NMDA–N-methyl D-aspartate; NSAIDs–non steroidal anti-inflammatory drugs; OFA–opioid free anesthesia; PACU–post anesthesia care unite; RASS–Richmond agitation sedation score; RR–respiratory rate; VAS–visual analogue score; VCV–volume controlled ventilation
Key words: Anesthesia; Anesthesia, Opioid free; Analgesia; VAS; Gynecological surgery; Lidocaine; Ketamine
Citation: Aboelela MA, Alrefaey AK. Opioid free versus opioid based anesthesia in abdominal gynecological surgery: a prospective randomized controlled trial. Anaesth. pain intensive care 2021;25(5):653–659; DOI: 10.35975/apic.v25i5.1642
Received: January 7, 2021, Reviewed: May 18, 2021, Accepted: September 10, 2021
