Shen Yanan, Wu Yuanyuan, Tang Qianqian, Wang Yilong, Ma Wei, Wang Jianwei
Department of Anesthesiology, School of Medicine, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
Front Med (Lausanne). 2025 Jul 17;12:1606383. doi: 10.3389/fmed.2025.1606383. eCollection 2025.
Postoperative nausea and vomiting (PONV) are a common complication following gynecological laparoscopic surgery, with opioid use being a significant contributing risk factor. Opioid-free anesthesia (OFA) has emerged as an alternative approach to mitigate opioid-related adverse effects. This study aimed to evaluate the efficacy of OFA in reducing PONV and its impact on postoperative recovery.
This randomized, double-blind, controlled trial enrolled 92 female patients undergoing elective gynecological laparoscopic surgery. The patients were randomized 1:1 into two groups, whereby the OFA group received anesthesia with esketamine (0.3 mg/kg) and dexmedetomidine (0.6 μg/kg), while the control group received conventional opioid-based anesthesia with sufentanil (0.3 μg/kg). Both groups underwent preoperative transversus abdominis plane (TAP) block with ropivacaine (20 mL per side). Standardized perioperative monitoring and analgesic protocols were maintained. The primary outcome was the incidence of PONV within 48 h postoperatively. Secondary outcomes included the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score recovery time, postoperative pain scores, antiemetic and analgesic use, and quality of recovery (QoR-15 scores).
On postoperative day 1, PONV incidence was significantly lower in the OFA group (15.2%) compared to the control group (34.8%) ( = 0.03), and by postoperative day 2, the difference between the groups was no longer statistically significant ( = 0.475). The OFA group exhibited a longer median extubation time (11.0 min vs. 5.5 min, < 0.001) and a prolonged MOAA/S recovery time (45.0 min vs. 40.0 min, = 0.012). Pain scores, postoperative sufentanil consumption, and QoR-15 scores did not differ significantly between groups. No patients in either group required postoperative supplemental analgesics, and three patients in each group received antiemetic treatment solely on the first postoperative day.
Opioid-free anesthesia incorporating TAP block may reduce early PONV following gynecological laparoscopic surgery while maintaining adequate pain control and overall recovery quality.
术后恶心呕吐（PONV）是妇科腹腔镜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。无阿片类药物麻醉（OFA）已成为减轻阿片类药物相关不良反应的替代方法。本研究旨在评估OFA在降低PONV方面的疗效及其对术后恢复的影响。
本随机、双盲、对照试验纳入了92例行择期妇科腹腔镜手术的女性患者。患者按1:1随机分为两组，OFA组接受艾司氯胺酮（0.3mg/kg）和右美托咪定（0.6μg/kg）麻醉，而对照组接受以舒芬太尼（0.3μg/kg）为基础的传统阿片类药物麻醉。两组均采用罗哌卡因（每侧20mL）进行术前腹横肌平面（TAP）阻滞。维持标准化的围手术期监测和镇痛方案。主要结局是术后48小时内PONV的发生率。次要结局包括改良观察警觉/镇静评估（MOAA/S）评分恢复时间、术后疼痛评分、止吐药和镇痛药的使用以及恢复质量（QoR-15评分）。
术后第1天，OFA组的PONV发生率（15.2%）显著低于对照组（34.8%）（P = 0.03），到术后第2天，两组之间的差异不再具有统计学意义（P = 0.475）。OFA组的中位拔管时间更长（11.0分钟对5.5分钟，P < 0.001），MOAA/S恢复时间延长（45.0分钟对40.0分钟，P = 0.012）。两组之间的疼痛评分、术后舒芬太尼消耗量和QoR-15评分没有显著差异。两组均无患者需要术后补充镇痛药，每组各有3例患者仅在术后第1天接受了止吐治疗。
采用TAP阻滞的无阿片类药物麻醉可降低妇科腹腔镜手术后早期PONV的发生率，同时维持充分的疼痛控制和总体恢复质量。
