Zhu Ya-Juan, Ying Yao-Yu, Liu Hua-Yue, Qian Long, Liu Hong, Ji Fu-Hai, Peng Ke
Department of Anaesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China.
Ann Med. 2025 Dec;57(1):2517819. doi: 10.1080/07853890.2025.2517819. Epub 2025 Jun 14.
Postoperative nausea and vomiting (PONV) are common complications after surgery. Opioid use is a significant risk factor. We utilised a crossover design to test this hypothesis in the same individuals that opioid-free anaesthesia (OFA) compared with opioid-inclusive anaesthesia reduces PONV.
This randomised double-blind crossover trial included adult patients undergoing two surgical procedures for lower extremity wounds under general anaesthesia. Each patient received both OFA (i.v. lidocaine, esketamine, dexmedetomidine and propofol) and opioid-inclusive anaesthesia (sufentanil and propofol); which came first was determined by randomisation. The primary outcome was the incidence of PONV during the first 48 h postoperatively. Secondary outcomes were the severity of PONV, use of rescue antiemetics, postoperative pain, need for rescue analgesia, adverse events, time to extubation, and length of recovery room stay.
Sixty-six patients completed this study (mean age 53 years, 36% female). The median washout period was 9 days. Compared with opioid-inclusive anaesthesia, OFA reduced the incidence of PONV 0-48 h postoperatively (5% vs. 23%, odds ratio [OR] = 0.13, 95% CI: 0.03-0.55, = 0.006), which remained significant in the prespecified adjusted analysis (OR = 0.06, 95% CI: 0.01-0.32, = 0.001). OFA also led to a reduced severity of PONV, a lower rate of hypotension, and a longer time to extubation. Postoperative pain and other outcomes were similar between the two anaesthetic techniques.
This crossover trial demonstrates that OFA reduced PONV following lower extremity wound surgery, providing compelling evidence for the administration of OFA to enhance perioperative care.
ChiCTR2200061511 (https://www.chictr.org.cn).
术后恶心呕吐（PONV）是手术后常见的并发症。使用阿片类药物是一个重要的危险因素。我们采用交叉设计，在同一组个体中检验与含阿片类药物麻醉相比，非阿片类药物麻醉（OFA）是否能降低PONV这一假设。
这项随机双盲交叉试验纳入了接受全身麻醉下下肢伤口两次外科手术的成年患者。每位患者均接受OFA（静脉注射利多卡因、艾司氯胺酮、右美托咪定和丙泊酚）和含阿片类药物麻醉（舒芬太尼和丙泊酚）；首先接受哪种麻醉由随机分组决定。主要结局是术后48小时内PONV的发生率。次要结局包括PONV的严重程度、使用解救性止吐药的情况、术后疼痛、是否需要解救性镇痛、不良事件、拔管时间以及恢复室停留时间。
66例患者完成了本研究（平均年龄53岁，36%为女性）。中位洗脱期为9天。与含阿片类药物麻醉相比，OFA降低了术后0 - 48小时PONV的发生率（5%对23%，优势比[OR]=0.13，95%置信区间：0.03 - 0.55，P = 0.006），在预先设定的校正分析中仍具有显著性（OR = 0.06，95%置信区间：0.01 - 0.32，P = 0.001）。OFA还导致PONV严重程度降低、低血压发生率降低以及拔管时间延长。两种麻醉技术术后疼痛及其他结局相似。
这项交叉试验表明，OFA可降低下肢伤口手术后的PONV，为采用OFA加强围手术期护理提供了有力证据。
ChiCTR2200061511（https://www.chictr.org.cn）
