Comparison of Opioid-Free and Opioid-Based Anesthesia for Postoperative Analgesia in Laparoscopic Urological Surgery: A Randomized Controlled Trial

Abstract

Introduction: Opioid-free anesthesia (OFA) aims to reduce opioid-related adverse effects and enhance recovery. This study compared opioid-free versus opioid-based anesthesia for postoperative analgesia in elective laparoscopic urological surgery.
Methods: In this randomized controlled trial, 70 adult patients scheduled for elective laparoscopic urological procedures were assigned to either an opioid-free (OF) or an opioid-based (OB) anesthesia group. The OF group received dexmedetomidine (loading dose 1 μg/kg over 10 minutes, maintenance 0.5 μg/kg/h), while the OB group received fentanyl at equivalent dosing. The primary outcome was the Visual Analog Scale at Rest (VAS-R) 1 hour after surgery. Secondary outcomes included VAS-R and VAS during coughing (VAS-C) at 0, 1, 2, 4, 6, 24 h; rescue analgesia; total 24-h tramadol use; and adverse events.
Results: VAS-R at 1 hour was significantly lower in the OF group (mean difference −0.94 (1.21)], p<0.005). Fewer OFA patients required rescue tramadol (28.6% vs 77.1%, p<0.001). Postoperative nausea and vomiting (PONV) occurred less frequently in the OF group (0% vs 14.3%, p<0.05). No serious adverse events occurred.
Conclusion: Dexmedetomidine-based OFA improved early postoperative analgesia, reduced opioid consumption, and lowered PONV rates compared with fentanyl anesthesia. OFA appears to be safe and consistent with enhanced recovery after surgery (ERAS) recommendations.