Opioid Free Anesthesia in Laparoscopic Cholecystectomy (Comparative Clinical Study)

Ahmed, Osama Helal; Noor El-Din, Tawfik Mohammed; Ali, Waheed Mohamed; Sayed, Zeinab Mustafa

doi:10.21608/ejhm.2020.69672

Opioid Free Anesthesia in Laparoscopic Cholecystectomy (Comparative Clinical Study)

Document Type : Original Article

Authors

¹ Department of Anesthesiology & Intensive Care Faculty of Medicine, Al Azhar University (Assuit)

² Department of Anesthesiology & Intensive Care, Faculty of Medicine, Al Azhar University (Cairo)

³ Department of Anesthesiology & Intensive Care, Faculty of Dentistry and Oral Medicine, South Valley University

10.21608/ejhm.2020.69672

Abstract

Background: Opioid Free Anesthesia aims to avoid perioperative opioids, instead uses adjuvant agents for their opioid-sparing effect which could also affect recovery rates and hospital length of stay (LOS). Patients and Methods: This prospective, randomized, single-blinded clinical study included 62 patients aged between 21 to 50 years, scheduled for LC. Group OA (n=31) received OA with fentanyl as the main anesthetic adjuvant and peri-operative analgesic. Group OFA (n=31) received OFA with dexmedetomidine, ketamine, and paracetamol as an anesthetic adjuvant and peri-operative analgesics. The intraoperative assessment included HR, systolic, diastolic and mean BP, the need for rescue analgesia or ephedrine. The postoperative assessment included the same values plus VAS score, Aldrete score, duration of stay in PACU, the incidence of side effects and complications and hospital LOS. Results: No significant difference between both groups regarding intraoperative hemodynamic values. In the group, OA 22 patients (70.9%) required intraoperative rescue analgesia (with mean dose 55.6 ± 37.4µg, median 70µg and highest dose of 100µg) compared to none in group OFA. In the group, OA 10 (32.3%) patients had PONV compared to 3 (9.7%) patients from group OFA which was statistically significant (P-value 0.033). No significant difference between both groups regarding postoperative VAS score, analgesic requirement, discharge time from PACU or LOS. Conclusions: The study showed that OFA was as effective as OA in maintaining intraoperative hemodynamic stability although group OFA showed the lower need for intraoperative analgesia. OFA also showed a significant reduction of incidence of PONV compared to group OA.

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