Opioid-free anesthesia for postoperative recovery after video-assisted thoracic surgery: A prospective, randomized controlled trial

Abstract

Purpose: Opioid-based anesthesia is a traditional form of anesthesia that has a significant analgesic effect; however, it can cause nausea, vomiting, delirium, and other side effects. Opioid-free anesthesia with dexmedetomidine and lidocaine has attracted widespread attention. This study aimed to compare the effects of opioid-free and opioid-based anesthesia (OFA and OBA, respectively) on postoperative recovery in patients who had undergone video-assisted thoracic surgery.

Methods: Eighty patients undergoing video-assisted thoracic surgery were assigned to receive either opioid-free anesthesia (OFA group) or opioid-based anesthesia (OBA group) according to random grouping. The primary outcome of the study was the quality of recovery-40 scores (QoR-40) 24 h postoperatively. The secondary outcome measure was numerical rating scale (NRS) scores at different times 48 h postoperatively. In addition to these measurements, other related parameters were recorded.

Results: Patients who received opioid-free anesthesia had higher QoR-40 scores (169.1 ± 5.1 vs. 166.8 ± 4.4, p = 0.034), and the differences were mainly reflected in their comfort and emotional state; however, the difference between the two groups was less than the minimal clinically important difference of 6.3. We also found that the NRS scores were lower in the OFA group than in the OBA group at 0.5 h (both p < 0.05) and 1 h (both p < 0.05) postoperatively and the cumulative 0-24 h postoperative dosage of sufentanil in the OBA group was higher than that in the OFA group (p = 0.030). There were no significant differences in postoperative nausea and vomiting (PONV) (p = 0.159). No surgical or block complications were observed between the groups.

Conclusion: Opioid-free analgesia potentially increased the postoperative recovery in patients who underwent video-assisted thoracic surgery.

Trial registration: The study protocol was registered in the Chinese Clinical Trial Register under the number ChiCTR2100045344 (http://www.chictr.org.cn/showproj.aspx?proj=125033) on April 13, 2021.

Keywords: analgesia; anesthesia; opioid-free; postoperative recovery; thoracic surgery.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

© 2023 Wang, Jia, Jiang, Li and Zhou.

Figures

Figure 1

Process chart of this study.

Figure 2

Global and dimension QoR-40 questionnaire score at 24 h post-surgery. Compared to the OBA group, the QoR-40 score was significantly higher in the OFA group (169.1 ± 5.1 vs. 166.8 ± 4.4, p = 0.034). In terms of physical comfort and emotional state, scores in the OFA group are significantly higher than those in the OBA group (physical comfort: 52.3 ± 2.5 vs. 50.7 ± 2.5, p = 0.007; emotional state: 39.5 ± 1.4 vs. 38.8 ± 1.3, p = 0.012), without differences in the other dimensions (both p > 0.05).

Figure 3

MAP and HR values at different intraoperative times. The differences in MAP and HR at different intraoperative times between the two groups were analyzed with the generalized estimation equation. The MAP in each group at different times and interaction effects are statistically different (both p < 0.001). The HR in each group at different times and interaction effects are statistically different (p < 0.001 and p = 0.012, respectively). T0: baseline value, T1: pre-induction of anesthesia, T2: lowest value after induction of anesthesia, T3: maximum value during endotracheal intubation, T4: value at the beginning of the operation, T5: half an hour after the start of the operation, T6: at the end of the operation, T7: 30 min after extubation. Abbreviation: MAP: mean arterial pressure; HR: heart rate. * Indicates a significant difference between groups.