A prospective randomized comparative analysis between opioid based anaesthesia vs opioid free anaesthesia on depth of anaesthesia and intraoperative hemodynamics in patients undergoing elective laparoscopic surgeries lasting less than 3 hours

Abstract

To avoid the adverse effects of opioid usage, an opioid-free multimodal approach for analgesia can be applied. This study was conducted with an aim to compare the effect of opioid-free anesthesia (dexmedetomidine, lignocaine, dexamethasone and ketamine) and opioid-based anesthesia (fentanyl) on maintaining depth of anaesthesia and intraoperative hemodynamic stability in patients scheduled for Laparoscopic surgeries. We conducted a prospective randomized comparative study on ASA Grade 1 – 2 patients admitted for laparoscopic abdominal surgeries sampling by block Randomization technique with sample size of 60 (30 in each group). In opioid based group, anaesthesia was induced with Inj. Fentanyl 2 mcg/kg before induction while in opioid-free group loading dose of Inj. Dexmedetomidine 1 mcg/kg over 10 min, infusion 0.5 mcg/kg/hr, Inj. Lignocaine 1.5 mg/kg, infusion of 1.5 mg/kg/hr after loading dose, Inj. Dexamethasone 8 mg, Inj. Ketamine 0.5 mg/kg was given. Intraoperatively, the hemodynamic stability and depth of anaesthesia was assessed by measuring the heart rate, blood pressure and BIS values.In the opioid-free group we had few significant decreases in HR and increases in MAP. The depth of anaesthesia was adequate and comparable to the opioid-based group. Hemodynamically, overall heart rates did not vary much between the two groups and the MAP values were higher in the opioid-free group closer to intubation and extubationOpioid-free, multimodal approach can safely replace the single opioid-based approach of anaesthesia management in the conduct of general anaesthesia.