Ahmed Abdelghaffar Rana, Ahmed Hamed Mohamed, Magdy Basiony Mohammed, Fouad Algyar Mohammad, Sayed Fargaly Omar, Ahmed Shawky Mohamed
Department of Anesthesiology, Faculty of Medicine, Fayoum University, Faiyum Governorate, Egypt.
Department of Anesthesiology, Faculty of Medicine, Kafrelsheikh University, Kafr El-Sheikh Governorate, Egypt.
Anesth Pain Med. 2024 Dec 16;14(6):e150997. doi: 10.5812/aapm-150997. eCollection 2024 Dec.
Opioid-free anesthesia (OFA) is a relatively new approach, and many studies are still needed to assess its effectiveness and compare it to opioid-based anesthesia (OBA).
This study investigated the use of OFA in obese patients undergoing upper limb surgery and compares its outcomes with those of OBA.Methods:This prospective randomized clinical study included 76 obese patients with a Body Mass Index (BMI) ≥ 30 kg/m² who were scheduled for upper limb surgery. Patients were randomly assigned to receive either OFA (group A, n = 38) or OBA (group B, n = 38). The OBA group was administered propofol, fentanyl, and atracurium, while the OFA group received lidocaine, propofol, atracurium, and dexmedetomidine. All patients were mechanically ventilated, and anesthesia was maintained with isoflurane and atracurium. Primary outcomes monitored included postoperative pain [Visual Analog Scale (VAS) ≥ 4] and the number of rescue doses of tramadol. Secondary outcomes included extubation time, any cardiac events, hypoxia, postoperative nausea and vomiting (PONV), intensive care unit (ICU) admission rates, and duration of hospital stay.
The OFA group had significantly lower extubation time, mean arterial pressure (MAP), and heart rate (HR) compared to the OBA group. Additionally, VAS scores were significantly lower at the 30-minute and 2-hour marks after extubation (P < 0.001 and P < 0.001, respectively) in patients receiving OFA. The OFA group also experienced fewer adverse effects, required fewer rescue doses of tramadol, and had shorter hospital stays.
Opioid-free anesthesia may result in better and safer outcomes for obese patients undergoing upper limb surgeries, with fewer postoperative complications and shorter hospital stays. However, further research is needed to fully understand the potential benefits of OFA compared to OBA.
无阿片类药物麻醉（OFA）是一种相对较新的方法，仍需要许多研究来评估其有效性，并将其与基于阿片类药物的麻醉（OBA）进行比较。
本研究调查了OFA在接受上肢手术的肥胖患者中的应用，并将其结果与OBA的结果进行比较。
这项前瞻性随机临床研究纳入了76例体重指数（BMI）≥30kg/m²且计划进行上肢手术的肥胖患者。患者被随机分配接受OFA（A组，n = 38）或OBA（B组，n = 38）。OBA组给予丙泊酚、芬太尼和阿曲库铵，而OFA组接受利多卡因、丙泊酚、阿曲库铵和右美托咪定。所有患者均接受机械通气，麻醉维持使用异氟烷和阿曲库铵。监测的主要结局包括术后疼痛[视觉模拟评分（VAS）≥4]和曲马多的挽救剂量数量。次要结局包括拔管时间、任何心脏事件、缺氧情况、术后恶心呕吐（PONV）、重症监护病房（ICU）入住率和住院时间。
与OBA组相比，OFA组的拔管时间、平均动脉压（MAP）和心率（HR）显著更低。此外，接受OFA的患者在拔管后30分钟和2小时时的VAS评分显著更低（分别为P < 0.001和P < 0.001）。OFA组的不良反应也更少，所需的曲马多挽救剂量更少，住院时间更短。
无阿片类药物麻醉可能为接受上肢手术的肥胖患者带来更好、更安全的结局，术后并发症更少，住院时间更短。然而，需要进一步研究以充分了解与OBA相比，OFA的潜在益处。
