Opioid Free Anesthesia in Laparoscopic Surgery: A New Emerging Technique

Background: Opioid-free anesthesia (OFA) is a new anesthesiological technique where opioid is avoided intra and post-operative due to side effects. Hence, this study compared opioid-free with opioid-based anesthesia for postoperative analgesia in laparoscopic surgeries. The primary objective was to assess pain scores in the postoperative period with the Numerical rating scale (NRS) for 24 hours, and the secondary objective was to compare intraoperative vitals, postoperative analgesia period, and utilization of total analgesics in the first 24 hours.
Materials and Methods: Prospective randomized control trial, 100 patients aged 20-70 years, American Society of Anaesthesiologists physical class I and II posted for elective upper and lower abdominal laparoscopic surgeries. Patients were divided into two groups (n=50 in each group): opioid-free (Group A) and opioid (Group B). Group A received anesthetic doses of lidocaine, magnesium, and paracetamol in combination with Erector spinae plane block for post-operative pain relief, while group B received intermittent doses of fentanyl. Postoperatively, NRS was observed at 0, 2, 4, and 6 hours during rest and at 0, 2, 4, 6, and 24 hours during movement. Data were analyzed by independent t-test.
Results: Group A showed a significant decrease in NRS score at rest at 0, 2, 4, and 6 hours, whereas there was a significant decrease in NRS score at movement in group A at 0, 2, 6, and 24 hours compared to group B (P< 0.05). Total duration of analgesia (hour) was significantly more in group A (17.86 ± 7.85) as compared to group B (7.76 ± 3.98) (P<0.001). Intraoperative vitals were comparable. The total rescue analgesia (milligram) requirement was significantly low in group A (0.92 ± 0.8) as compared to group B (2.02 ± 0.38).
Conclusion: For patients undergoing elective upper and lower abdominal laparoscopic surgeries, multimodal analgesia was safe in unwanted opioid side-effects cases and unavailability of opioids.