Comparison of Postoperative Analgesic Efficacy Between Opioid-free Anaesthesia Using Intravenous Magnesium, Lidocaine, and Erector Spinae Plane Block, and Opioid-based Anaesthesia in Laparoscopic Abdominal Surgeries: A Randomised Controlled Trial.

OBJECTIVE

Opioid-based anaesthesia is a standard practice in laparoscopic surgeries. However, it is associated with adverse effects that can limit its use. To address these issues, opioid-free anaesthesia has been introduced as an alternative. This study aims to compare the analgesic efficacy of opioid-free anaesthesia, incorporating magnesium, lidocaine, and an erector spinae plane block (ESPB), with traditional opioid-based anaesthesia during laparoscopic procedures.

METHODS

Seventy patients aged 18-60 years undergoing laparoscopic surgery were randomly divided into two groups of 35 each. Opioid-free group received opioid-free anaesthesia, which included an intravenous (IV) bolus of 2 g magnesium, a continuous lidocaine infusion at 1.5 mg kg-1 hr-1, and a bilateral ESPB with 25 mL of 0.25% bupivacaine. Opioid-based group received opioid-based anaesthesia with an IV dose of 2 μg kg-1 fentanyl. Postoperative pain and the need for rescue analgesia were assessed for 24 h. Perioperative haemodynamic parameters were recorded, and the incidence of postoperative complications, including sedation, nausea, vomiting, and shivering, was monitored for 24 h.

RESULTS

Pain scores were significantly lower in the opioid-free group compared to the opioid-based group at 0 h (P < 0.001), 2 h (P < 0.001), and 4 h (P=0.005) postoperatively. The opioid-based group required rescue analgesia more frequently (P < 0.001). Additionally, the incidence of postoperative complications was significantly lower in the opioid-free group than in the opioid-based group (P < 0.001). Haemodynamic parameters were similar between the two groups.

CONCLUSION

Opioid-free anaesthesia provides superior postoperative analgesia and reduces the incidence of postoperative complications compared with opioid-based anaesthesia for laparoscopic surgery.