Opioid-free anesthesia improves postoperative recovery quality of small and medium-sized surgery: a prospective, randomized controlled study

被引:3
作者
Wang, Pei [1 ]
Zhou, Xia [1 ]
Wang, Shijie [2 ]
Sheng, Fang [1 ]
Liu, Cuicui [1 ]
Wang, Yanting [1 ]
Jiang, Lili [1 ]
Wang, Juntao [1 ]
Feng, Wei [1 ]
机构
[1] Qingdao Univ, Dept Anesthesiol, Affiliated Hosp, Qingdao 266000, Peoples R China
[2] Univ Qingdao, Dept Pain Management, Affiliated Hosp Qingdao Univ, Qingdao, Peoples R China
关键词
Esketamine; Dexmedetomidine; Postoperative nausea and vomiting; DEXMEDETOMIDINE; NAUSEA;
D O I
10.23736/S0375-9393.24.18125-4
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Opioid anesthesia (OA) is currently the predominant anesthetic method. However, its associated side effects, such as nausea and vomiting, coupled with the principle of enhanced recovery after surgery (ERAS), have spurred the adoption of opioid-free anesthesia (OFA) in select surgical procedures. For small and medium-sized operations, ERAS is particularly important. The aim of this study was to investigate the effect of OFA, utilizing esketamine in combination with dexmedetomidine and sevoflurane, on postoperative recovery quality following small and medium-sized surgical interventions. METHODS: A total of 120 patients who underwent various small and medium-sized operations were randomly allocated to OFA and OA groups. The OA group received sufentanyl and sevoflurane, while the OFA group received esketamine, dexmedetomidine, and sevoflurane. The primary outcome measure was the postoperative quality of recovery-40 scores (QoR-40) 24 hours after surgery. Secondary outcomes included hemodynamic changes at different time intervals, the incidences of adverse events were recorded. RESULTS: Patients in the OFA group exhibited a higher QoR-40 score of 184.0 (182.0, 186.2) compared to 182.0 (180.0, 184.0) in the OA group (P<0.001). The disparities were particularly noble in terms of Physical comfort and Emotional status. Multivariable analysis identified postoperative nausea and vomiting (PONV) as a significant independent factor impacting QoR-40 ((3-4.49 [-6.1,-2.87], P<0.001). Hemodynamic stability was more pronounced in the OFA than in the OA group. The incidence of PONV was substantially lower in the OFA group (one [1.6%] vs. 14 [25%], P<0.001), with a reduced need for vasoactive drugs (five [7.8%] vs. 15 [26.8%], P30.005), and a lower incidence of respiratory depression (0 [0%] vs. six [10.7%], P30.009). CONCLUSIONS: OFA improves the postoperative recovery quality in small and medium-sized surgical procedures, potentially attributed to decreased incidence of PONV. Additionally, OFA facilitates the maintenance of more stable hemodynamics throughout the operation.
引用
收藏
页码:759 / 768
页数:10
相关论文
共 28 条
  • [1] Effectiveness and safety of intravenous application of dexmedetomidine for cesarean section under general anesthesia: a meta-analysis of randomized trials
    Ao, Li
    Shi, Jinlin
    Bai, Yaowu
    Zheng, Yujuan
    Gan, Janhui
    [J]. DRUG DESIGN DEVELOPMENT AND THERAPY, 2019, 13 : 965 - 974
  • [2] Evidence-based analysis of risk factors for postoperative nausea and vomiting
    Apfel, C. C.
    Heidrich, F. M.
    Jukar-Rao, S.
    Jalota, L.
    Hornuss, C.
    Whelan, R. P.
    Zhang, K.
    Cakmakkaya, O. S.
    [J]. BRITISH JOURNAL OF ANAESTHESIA, 2012, 109 (05) : 742 - 753
  • [3] Choi H, 2022, J PAIN RES, V15, P2197, DOI [10.2147/JPR.S373412, 10.2147/JPR.S373412DovePress]
  • [4] Systemic Lidocaine to Improve Postoperative Quality of Recovery After Ambulatory Laparoscopic Surgery
    De Oliveira, Gildasio S., Jr.
    Fitzgerald, Paul
    Streicher, Lauren F.
    Marcus, R-Jay
    McCarthy, Robert J.
    [J]. ANESTHESIA AND ANALGESIA, 2012, 115 (02) : 262 - 267
  • [5] Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial
    de Paula Gomes Miziara, Luiz Eduardo
    Simoni, Ricardo Francisco
    Esteves, Luis Otavio
    Cangiani, Luis Henrique
    Ribeiro Grillo-Filho, Gil Fernando
    Lima e Paula, Anderson Garcia
    [J]. ANESTHESIOLOGY RESEARCH AND PRACTICE, 2016, 2016
  • [6] Opioid-Free Anesthesia for Lung Cancer Resection: A Case-Control Study
    Devine, Gary
    Cheng, Maureen
    Martinez, Guillermo
    Patvardhan, Chinmay
    Aresu, Giuseppe
    Peryt, Adam
    Coonar, Aman S.
    Roscoe, Andrew
    [J]. JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2020, 34 (11) : 3036 - 3040
  • [7] The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography A randomised controlled multicentre trial
    Eberl, Susanne
    Koers, Lena
    van Hooft, Jeanine
    de Jong, Edwin
    Hermanides, Jeroen
    Hollmann, Markus W.
    Preckel, Benedikt
    [J]. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2020, 37 (05) : 394 - 401
  • [8] Farghaly HSM, 2014, PAIN PHYSICIAN, V17, P187
  • [9] Fiore JF Jr, 2022, LANCET, V399, P2280, DOI 10.1016/S0140-6736(22)00582-7
  • [10] Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis
    Frauenknecht, J.
    Kirkham, K. R.
    Jacot-Guillarmod, A.
    Albrecht, E.
    [J]. ANAESTHESIA, 2019, 74 (05) : 651 - 662