Evaluating Opioid-Free Anesthesia in Thoracoscopic Surgery

In a randomized, single-center trialof 60 adults undergoing thoracoscopic surgery, investigators reported that a ketamine-dexmedetomidine opioid-free anesthesia regimen was associated with lower early postoperative pain scores than a fentanyl-based regimen during the first postoperative day.

The opioid-free group received ketamine at induction with a dexmedetomidine infusion during maintenance alongside isoflurane, whereas the opioid group received fentanyl at induction with isoflurane maintenance. Pain was assessed with a visual analog scale (VAS) at prespecified intervals spanning recovery and postoperative checks through 24 hours.

The study reported significantly lower VAS scores in the opioid-free group during recovery and at 2, 12, and 18 hours after surgery. Rescue analgesia followed the same protocol in both groups (intravenous acetaminophen when VAS exceeded 3), and the authors reported no significant between-group difference in total postoperative acetaminophen dose.

Postoperative hemodynamic indices and other bedside clinical parameters were tabulated on the same schedule. Heart rate was reported to be significantly lower in the opioid-free arm at 6, 8, and 12 hours after surgery compared with the fentanyl-based group. Over the observation window, systolic and diastolic blood pressure values were presented without statistically significant between-group differences as reported by the investigators.

Laboratory results were reported as perioperative comparisons that included inflammatory and renal indices. The investigators reported statistically significant postoperative differences in C-reactive protein (CRP), blood urea nitrogen (BUN), and creatinine, with higher values in the opioid-free group than in the opioid group.

The investigators reported no significant difference in the prevalence of postoperative complications between groups over the first 24 hours, including tracked symptoms such as pruritus, nausea, and vomiting, and they described standardized postoperative rescue analgesia without escalation to other systemic or regional modalities during that interval.

Key Takeaways:

• The article reported lower early postoperative VAS pain scores in the opioid-free group at selected assessments, with other timepoints described as not significantly different.
• Heart rate was reported lower in the opioid-free arm at selected postoperative hours, while blood pressure measures were presented without significant between-group differences.
• Postoperative CRP, BUN, and creatinine were reported higher in the opioid-free group, alongside no significant differences reported for recorded complications or total rescue acetaminophen dosing over 24 hours.