Evaluation of the Efficacy and Safety of Opioid-Free Anesthesia Compared with Conventional Opioid-Based General Anesthesia in Patients Undergoing Elective Laparoscopic Cholecystectomy

Abstract

Background: Opioids are commonly used during general anaesthesia but are associated with adverse effects such as postoperative nausea and vomiting, respiratory depression, delayed recovery, and increased opioid consumption.   Opioid-free anaesthesia (OFA) using multimodal non-opioid agents has emerged as an alternative approach to improve perioperative outcomes. This study aimed to compare the efficacy and safety of opioid-free anaesthesia with conventional opioid-based anaesthesia in patients undergoing elective laparoscopic cholecystectomy. Materials and Methods: This prospective randomised controlled comparative study was conducted in the Department of Anaesthesiology at CSI Redfern Memorial Hospital, Hassan, over a period of 2 years. A total of 74 patients undergoing elective laparoscopic cholecystectomy were randomised into two groups: Group OFA (n=37) received dexmedetomidine and lidocaine-based opioid-free anaesthesia, while Group OBA (n=37) received conventional fentanyl-based opioid anaesthesia. Intraoperative hemodynamic parameters, recovery profile, postoperative pain scores, rescue analgesic requirement, postoperative nausea and vomiting, patient satisfaction, and adverse events were assessed. Results: Both groups were comparable in baseline demographic and clinical characteristics. Patients in the OFA group demonstrated significantly better intraoperative hemodynamic stability with lower heart rate and mean arterial pressure changes during intubation, pneumoperitoneum, and extubation (p<0.001). Recovery was faster in the OFA group, with reduced extubation and orientation times (p<0.001). Postoperative pain scores were significantly lower, and time to first rescue analgesia was prolonged in the OFA group (p<0.001). The incidence of postoperative nausea and vomiting was significantly reduced in the OFA group compared with the OBA group (8.1% vs 29.7%, p=0.02). Patient satisfaction was also significantly higher among patients receiving opioid-free anaesthesia (p=0.04). Both techniques showed acceptable safety profiles. Conclusion: Opioid-free anaesthesia provides superior perioperative outcomes compared with conventional opioid-based anaesthesia in elective laparoscopic cholecystectomy. It offers improved hemodynamic stability, better postoperative analgesia, faster recovery, reduced opioid-related complications, and higher patient satisfaction while maintaining safety.

Keywords: Opioid-free anaesthesia; Opioid-based anaesthesia; Dexmedetomidine; Laparoscopic cholecystectomy; Postoperative analgesia; Recovery profile.