Pandya Niyati, Patel Neeta, Bhimbha Charmi, Upadhyay Nandan, Mehta Nishit, Jani Parth
Anaesthesiology, All India Institute of Medical Sciences, Rajkot, Rajkot, IND.
Anaesthesiology, C U Shah Medical College and Hospital, Surendranagar, IND.
Cureus. 2025 Jun 20;17(6):e86421. doi: 10.7759/cureus.86421. eCollection 2025 Jun.
Laparoscopic surgery, though minimally invasive, often results in significant postoperative pain, particularly in the initial hours. While opioids remain a conventional analgesic choice, their use is associated with adverse effects, including respiratory depression, sedation, nausea, and dependency. This study aimed to evaluate the efficacy of opioid-free multimodal analgesia using epidural with general anesthesia to minimize opioid requirements and related complications.
This observational study was conducted on 50 patients aged >20 years, with American Society of Anesthesiologists (ASA) grade I, II, and III, posted for surgeries under general anesthesia at C.U. Shah Medical College and Hospital, Surendranagar from January 2021 to June 2022 to evaluate opioid free anesthesia in major laparoscopic surgeries on perioperative hemodynamics and postoperative analgesia. The patients were given general anesthesia with epidural anesthesia.
The study population comprised 42 (84%) female and eight (16%) male patients. Hemodynamic monitoring showed stable parameters with no significant variations in heart rate after non-depolarizing muscle relaxant administration, at one hour, two hours, and four hours postoperatively. Similarly, systolic blood pressure, diastolic blood pressure, and mean arterial pressure remained stable at all measured time points. Pain assessment using the visual analog scale revealed mild discomfort at extubation (mean score: 2.76 ± 0.64), which progressively decreased over the subsequent 24 hours. Sedation level, measured by the Ramsay Sedation Scale, was at its peak at extubation (3.72 ± 0.48) and gradually declined to near-baseline levels by four hours post extubation (1.96 ± 1.13). Cognitive function evaluation using the Montreal Cognitive Assessment showed no significant difference between preoperative (27.9 ± 1.37) and 24-hour postoperative (26.72 ± 1.37) scores. The incidence of postoperative nausea and vomiting was 18%, successfully managed with 0.15 mg/kg ondansetron, with no other complications reported.
Opioid-free anesthesia combining epidural ropivacaine with general anesthesia provides effective analgesia in laparoscopic surgeries, as evidenced by stable hemodynamics, acceptable pain scores, minimal sedation, high patient satisfaction, and no significant cognitive impairment. This approach may serve as a viable alternative to opioid-based analgesia, reducing associated side effects.
腹腔镜手术虽然微创，但术后常导致显著疼痛，尤其是在术后最初几个小时。虽然阿片类药物仍然是传统的镇痛选择，但其使用与不良反应相关，包括呼吸抑制、镇静、恶心和成瘾。本研究旨在评估硬膜外联合全身麻醉的无阿片类多模式镇痛的疗效，以尽量减少阿片类药物的需求及相关并发症。
本观察性研究对2021年1月至2022年6月在苏伦德拉纳加尔的C.U. Shah医学院和医院接受全身麻醉手术的50例年龄>20岁、美国麻醉医师协会（ASA）分级为I、II和III级的患者进行，以评估在大型腹腔镜手术中无阿片类麻醉对围手术期血流动力学和术后镇痛的影响。患者接受全身麻醉联合硬膜外麻醉。
研究人群包括42例（84%）女性和8例（16%）男性患者。血流动力学监测显示参数稳定，在给予非去极化肌松药后、术后1小时、2小时和4小时心率无显著变化。同样，在所有测量时间点，收缩压、舒张压和平均动脉压均保持稳定。使用视觉模拟量表进行的疼痛评估显示，拔管时轻度不适（平均评分：2.76±0.64），在随后24小时内逐渐减轻。通过Ramsay镇静量表测量的镇静水平在拔管时达到峰值（3.72±0.48），拔管后4小时逐渐降至接近基线水平（1.96±1.13）。使用蒙特利尔认知评估进行的认知功能评估显示，术前（27.9±1.37）和术后24小时（26.72±1.37）评分无显著差异。术后恶心呕吐发生率为18%，使用0.15 mg/kg昂丹司琼成功处理，未报告其他并发症。
硬膜外罗哌卡因联合全身麻醉的无阿片类麻醉在腹腔镜手术中提供了有效的镇痛，血流动力学稳定、疼痛评分可接受、镇静轻微、患者满意度高且无显著认知障碍证明了这一点。这种方法可能是基于阿片类药物镇痛的可行替代方案，可减少相关副作用。
