Clinical Study On The Effect Of Opioid-free Anesthesia On The Recovery Quality Of Patients In Hysteroscope

Background:Anesthesia with opioids negatively effects patients’ quality of recovery,and opioid-free anesthesia attempts to avoid these effects.This study aimed to evaluate the effect of opioid-free anesthesia with lidocaine on the quality of recovery of patients undergoing hysteroscopy.Objective: Whether OFA recovered more quickly after gynaecological hysteroscopy than lidocaine and sufentanil,and improved the quality of recovery and the risk of side effects.Methods:A parallel group,randomized,double-blind,controlled trial was conducted in Yichang Central People’s Hospital,Hubei Province,China from January to April 2022.We enrolled 90 women(ages 18-65,American College of Anesthesiologists Class I-II Medical condition)scheduled for elective hysteroscopy who were randomly assigned to receive either lidocaine or sufentanil perioperatively,45 receiving lidocaine(group L)and 45 receiving sufentanil(group S).Group L was induced with 1.5mg/kg lidocaine,group S was induced with0.3ug/kg sufentanil,followed by 2mg/kg propofol and 10mg/kg succinylcholine,and then appropriate size laryngeal mask placement was carried out.During the operation,the L group was injected with 1.5mg/kg·h lidocaine,and the S group was injected with the same volume of normal saline.The primary outcome was the quality of postoperative recovery assessed using the QoR-40 questionnaire.Secondary outcomes included the patient’s 24 h pain score,immediate postoperative throat pain score,postoperative wake time and extubation time,propofol injection pain,intraoperative hemodynamic changes,intraoperative ratio of hydroxyamine to atropine,and postoperative incidence of nausea and vomitingResults:The two groups were similar in age,American Society of Anesthesiology status,height,weight,body mass index,and duration of surgery and anesthesia.(1)The QoR score of group L(177.2±6.2)was significantly higher than that of group S(172.6±5.4).(2)The pain score of the L group was decreased by about 0.5 points immediately and within 1 hour after surgery compared with that of the S group(P < 0.05),but there was no significant difference between 4h and 24h(P > 0.05).(3)The score of postoperative throat pain,the score of L group was 0.4 points lower than that of S group(P < 0.05).(4)Extubation and wakefulness time of group L were about 1min earlier than that of group S,which had certain clinical significance(P < 0.05).(5)No moderate or severe propofol injection pain was observed in group L,while 13.3%of patients in group S had moderate or severe propofol injection pain(P<0.05).(6)No patients in group L received atropine during the operation,and 9 patients(20%)received m-hydroxyamine during the operation,while 20 patients(44.44%)received atropine and 22 patients(48.89%)received m-hydroxyamine in group S(P<0.05).(7)At 5 minutes after intubation,MAP changes in group L were significantly more stable than those in group S,and the overall change rate did not exceed 20% of the basic blood pressure.At 1min and 2min after intubation,the heart rate in group L was significantly higher than the basic value,but did not exceed 20% of the basic heart rate.Conclusion:Opioid-free anesthesia with lidocaine achieves a better quality of recovery,prompt recovery,and a shorter time to extubation than general anesthesia with sufentanil.Less incidence of postoperative nausea and vomiting.