The Feasibility Of Opioid-Free Anesthesia With Combined Use Of Esketamine,Dexmedetomidine And Sevoflurane In Intermediate Or Minor Surgery

Objective:Opioids are commonly used as analgesic drugs in clinical anesthesia,but their use produces adverse effects such as postoperative nausea and vomiting(PONV),postoperative pain,hyperalgesia,postoperative respiratory depression,postoperative agitation and delirium,which are detrimental to patient recovery.Therefore,based on the concept of multimodal analgesia,the concept of opioid-free anesthesia(OFA)was generated,which is based on the concept of replacing opioids in general anesthesia by combining multiple analgesic drugs as a way to avoid the adverse effects of opioids.In this study,a combination of esketamine,dexmedetomidine and sevoflurane was used to explore the feasibility of opioid-free anesthesia in intermediate or minor surgery and its advantages over opioid anesthesiaMethods:Sixty patients undergoing intermediate or minor surgery at the Affiliated hospital of Qingdao University from November 2021 to February 2022 were randomly divided into the opioid-free anesthesia group(OFA group)and the traditional opioid anesthesia group(OA group),with 30 patients in each group.Main outcome indicators:The mean arterial pressure(MAP)and heart rate(HR)at the time points of before anesthsia(T0),3 minutes before intubation(T1),3 minutes after intubation(T2),at the time of skin excision(T3),at 5 minutes(T4),10 minutes(T5),and 15minutes after skin excision(T6),at the time of extubation(T7)and awakening(T8).Secondary outcome indicators:The visual analogue scale(VAS)scores immediately after anesthesia awakening,4h after surgery,and 24h after surgery.The use of flurbiprofen axetil injection within 24 hours after surgery.The use of intraoperative vasoactive drugs.The time required for extubation,awakening and postanesthesia care unit(PACU)stay.The incidence of respiratory depression and agitation after extubation,nausea and vomiting within24h after surgery,and postoperative delirium.The intraoperative bispectral index(BIS)and the incidence of intraoperative awareness.Results:Comparison of MAP and HR between groups at each time point in the perioperative period:there was no statistically significant difference between the two groups from T0 to T1(P>0.05),the MAP and HR in OFA group were higher than those in OA group from T2 to T6and lower than those in OA group from T7 to T8(F=5.146～44.145,P<0.05).Comparison of MAP and HR within groups from T2 to T6:the differences between MAP and HR in the OFA group compared with the previous time point were not statistically significant(P>0.05),MAP was significantly lower in the OA group at T3 compared with T2(F=0.462,P<0.05),and the difference between the fluctuations of MAP and HR at the remaining time points compared with the previous time point was not statistically significant(P>0.05).The VAS scores immediately after anesthesia awakening,4h after surgery,and 24h after surgery were lower than those of OA group(F=6.318～20.332,P<0.05).The use of flurbiprofen axetil injection within 24 hours after surgery was lower than that in OA group.The use of atropine and ephedrine in OFA group was lower than that in OA group(χ~2=4.812、7.925,P<0.05).The difference in the use of norepinephrine between the two groups was not statistically significant(P>0.05).The time required for extubation,awakening and PACU stay of OFA group were longer than OA group(t=2.015～4.354,P<0.05).The incidence of postoperative nausea and vomiting within 24 hours after surgery,respiratory depression and agitation after extubation was less in OFA group than in OA group(χ~2=11.882、6.667,t=-3.268,P<0.05).The intraoperative BIS of OFA group was higher than that in OA group(F=86.485～298.646,P<0.05).No postoperative delirium and intraoperative awareness occurred in either group.Conclusion:The use of opioid-free anesthesia with a combination of esketamine,dexmedetomidine,and sevoflurane is safe and feasible for intermediate or minor surgery.Its hemodynamics are more stable during intraoperative,extubation and anesthesia awakening,with good analgesic and sedative effects,effectively avoiding the adverse effects of opioids such as postoperative pain,respiratory depression and agitation after extubation,postoperative nausea and vomiting,and well promoting postoperative recovery.