Xiong Miaomiao, Liu Yao, Liang Yingsi, Wang Hailang, Zhang Lili, Zhang Zhongjun, Fang Ming
Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China.
Department of Pain Management, Affiliated Hospital of Jiangnan University, Wuxi, People's Republic of China.
J Pain Res. 2025 Apr 23;18:2137-2146. doi: 10.2147/JPR.S506147. eCollection 2025.
Enhanced recovery after surgery emphasizes effective analgesia while minimal opioid use. Opioid-free anesthesia (OFA) and opioid-sparing anesthesia (OSA) have been shown to enhance recovery by reducing opioid-induced side effects. This study compared the efficacy of OFA and OSA in managing postoperative pain and recovery after laparoscopic cholecystectomy (LC).
A single-center, randomized controlled trial was conducted with 86 adults undergoing LC. Patients received either OSA (sufentanil/remifentanil) or OFA (no opioids). Both groups received propofol, esketamine, dexmedetomidine, and erector spinae plane block. The primary outcome was pain area under the curve (AUCVAS) within 36 hours postsurgery. Secondary outcomes included hemodynamics, recovery times and bowel function.
Eighty-one patients (41 and 40 in the OFA and OSA groups, respectively) completed the study. The AUCVAS scores were similar between the OFA (7.3 ± 1.4) and OSA (6.9 ± 1.3) groups (P = 0.201), the difference in AUCVAS between the two groups was 0.384 (95% CI: -0.296, 1.064), which was significantly below the preset noninferiority threshold of 1.0, demonstrating the noninferiority of OFA. While early pain scores within the first 12 hours postanesthesia care unit (PACU) discharge were slightly higher in the OFA group, but overall pain control was sufficient in both groups. The VAS scores from PACU discharge to 36 hours postoperatively, intraoperative hemodynamic variables, and the need for rescue analgesia were comparable. OFA patients experienced a faster bowel recovery (13.8 ± 2.4 vs 15.5 ± 2.3 hours, P = 0.002). Recovery times, postoperative QoR-40 scores, and patient satisfaction were similar between the groups.
OFA is noninferior to OSA in pain management and hemodynamic stability, with faster bowel recovery after LC.
术后加速康复强调有效镇痛的同时尽量减少阿片类药物的使用。无阿片类麻醉（OFA）和阿片类药物节省麻醉（OSA）已被证明可通过减少阿片类药物引起的副作用来促进恢复。本研究比较了OFA和OSA在腹腔镜胆囊切除术（LC）后疼痛管理和恢复方面的疗效。
对86例接受LC的成年人进行了一项单中心随机对照试验。患者接受OSA（舒芬太尼/瑞芬太尼）或OFA（不使用阿片类药物）。两组均接受丙泊酚、艾司氯胺酮、右美托咪定和竖脊肌平面阻滞。主要结局是术后36小时内的疼痛曲线下面积（AUCVAS）。次要结局包括血流动力学、恢复时间和肠功能。
81例患者（OFA组41例，OSA组40例）完成了研究。OFA组（7.3±1.4）和OSA组（6.9±1.3）的AUCVAS评分相似（P = 0.201），两组之间AUCVAS的差异为0.384（95%CI：-0.296，1.064），显著低于预设的非劣效性阈值1.0，表明OFA的非劣效性。虽然麻醉后护理单元（PACU）出院后前12小时内OFA组的早期疼痛评分略高，但两组的总体疼痛控制均足够。从PACU出院到术后36小时的VAS评分、术中血流动力学变量以及补救性镇痛的需求相当。OFA组患者的肠道恢复更快（13.8±2.4小时对15.5±2.3小时，P = 0.002）。两组之间的恢复时间、术后QoR-40评分和患者满意度相似。
在疼痛管理和血流动力学稳定性方面，OFA不劣于OSA，且LC术后肠道恢复更快。
