Li Guohua, Lv Yingbing, Gao Song, Yao Xinyu, Ren Shaohui, Dong Liyuan, Li Xiao
Department of Anesthesiology, Xingtai People's Hospital, Xingtai, Heibei, 054001, China.
Operating Room, Xingtai People's Hospital, Xingtai, Heibei, 054001, China.
BMC Anesthesiol. 2025 Aug 25;25(1):422. doi: 10.1186/s12871-025-03301-w.
Opioid-free anesthesia (OFA) protocols using esketamine and dexmedetomidine have shown potential benefits for perioperative pain control with fewer side effects. We explored whether an esketamine–dexmedetomidine OFA regimen accelerates bowel recovery and preserves cognitive function after laparoscopic total hysterectomy.
In this prospective observational cohort study, we enrolled 114 women undergoing elective total laparoscopic hysterectomy (TLH). Anesthesia technique—esketamine–dexmedetomidine–based OFA (OFA group) versus standard opioid-based anesthesia (OBA group)—was chosen by the attending anesthesiologist. Key perioperative variables, including drug dosages and rescue analgesics, were recorded. The primary outcome was the time to first bowel movement. Secondary endpoints included incidence of postoperative ileus, pain scores, opioid consumption, and postoperative cognitive function assessed by the Montreal Cognitive Assessment (MoCA) at baseline and postoperative Days 1 and 3.
Among the 114 participants (OFA group = 59; OBA group = 55), median time to first bowel movement was significantly shorter in the OFA group (42 h [IQR 38–48]) compared with the OBA group (49 h [IQR 42–56]; < 0.01). Postoperative ileus occurred in 6% of OFA patients versus 15% of OBA patients ( = 0.07). Postoperative MoCA scores showed a smaller decline from baseline in the OFA group (mean difference − 1.2 ± 1.0) compared with the OBA group (− 2.3 ± 1.5; < 0.05). Use of rescue opioids was lower in the OFA group (23% vs. 42%; = 0.02).
Esketamine–dexmedetomidine–based OFA approach was associated with faster return of bowel function and reduced cognitive decline compared to standard opioid-based anesthesia in women undergoing TLH, without compromising analgesia or safety. These observational findings warrant confirmation in randomized trials.
使用艾司氯胺酮和右美托咪定的无阿片类麻醉（OFA）方案已显示出在围手术期疼痛控制方面具有潜在益处，且副作用较少。我们探讨了艾司氯胺酮 - 右美托咪定OFA方案是否能加速腹腔镜全子宫切除术后肠道恢复并保留认知功能。
在这项前瞻性观察性队列研究中，我们纳入了114例行择期腹腔镜全子宫切除术（TLH）的女性。麻醉技术由主治麻醉医师选择，即基于艾司氯胺酮 - 右美托咪定的OFA（OFA组）与基于标准阿片类药物的麻醉（OBA组）。记录围手术期的关键变量，包括药物剂量和补救性镇痛药的使用情况。主要结局是首次排便时间。次要终点包括术后肠梗阻的发生率、疼痛评分、阿片类药物消耗量，以及通过蒙特利尔认知评估（MoCA）在基线、术后第1天和第3天评估的术后认知功能。
在114名参与者中（OFA组 = 59；OBA组 = 55），OFA组首次排便的中位时间（42小时[四分位间距38 - 48]）明显短于OBA组（49小时[四分位间距42 - 56]；P < 0.01）。OFA组6%的患者发生术后肠梗阻，而OBA组为15%（P = 0.07）。与OBA组（-2.3 ± 1.5）相比，OFA组术后MoCA评分从基线的下降幅度较小（平均差异 -1.2 ± 1.0；P < 0.05）。OFA组补救性阿片类药物的使用率较低（23%对42%；P = 0.02）。
与接受TLH的女性采用的基于标准阿片类药物的麻醉相比，基于艾司氯胺酮 - 右美托咪定的OFA方法与更快的肠道功能恢复和认知功能下降减少相关，且不影响镇痛效果或安全性。这些观察结果有待在随机试验中得到证实。
