The Takeaway
The opioid free regimen reduced the overall incidence of PONV and reduced the risk of developing first postoperative PONV compared to standard opioid-based general anesthesia - without an increase in pain scores at rest or with movement after surgery.
Study Design
- blinded, randomized, parallel-group trial
- 168 patients aged 18–65 years
- Exclusion Criteria: excluded: ASA) ≥ IV, BMI > 35 kg/m2; unable to communicate before surgery; received radiation therapy, chemotherapy, opioids or hormonal drugs within 14 days before surgery; intolerant of the anesthesia protocol, such as nerve block contraindications, allergies to medication; expected to experience prolonged mechanical ventilation usage after surgery;
- Opioid free anesthesia regimen included a thoracic paravertebral block (20 ml of 0.5% ropivacaine) at T5 level. A dexmedetomidine bolus (0.5 ug/kg for 15 min) before induction, lidocaine (1.5 mg/kg) intravenous for induction, and followed by dexmedetomidine (0.5 ug/kg/h) and lidocaine (1.5 mg/kg/h) infusions during surgery
- PONV and pain severity were assessed at 24 and 48 h after surgery
Excerpts
Postoperative nausea and vomiting (PONV) is a common complication, with an incidence of 30%~40% in video-assisted thoracic surgery under general anesthesia
Opioids contribute to PONV through various mechanisms, including direct stimulation of opioid receptors, delayed gastric emptying, sensitization of the vestibular system, and triggered release of histamine. Other concerns of opioids use include ventilation disturbances, hyperalgesia, and the potential for addiction
The median score of PONV severity was lower in the OFA group than in the OBA group
the optimal protocol for implementing OFA remains unclear
Abstract
Objectives: Postoperative nausea and vomiting (PONV) is common after video-assisted thoracic surgery, which may be associated with the use of intraoperative opioids. We tested the hypothesis that balanced opioid-free anesthesia (OFA) might reduce the incidence of PONV after video-assisted thoracic surgery.
Methods: One hundred and sixty-eight adults undergoing video-assisted thoracic assisted surgery were randomly assigned to receive balanced opioid-free anesthesia or balanced opioid-based anesthesia (OBA). The primary outcome was the incidence of PONV, which was assessed with the Myles's simplified PONV impact scale during the initial 24 h after surgery.
Results: Compared with OBA group, the overall incidence of PONV in OFA group was significant reduced (14.6% vs. 30.1%, P = 0.017), and OFA reduced the risk of PONV events within 24 h of surgery (HR, 0.44; 95%CI: 0.22-0.87, P = 0.018). The incidence of other postoperative complications in OFA group was lower than that in OBA group (19.5% vs. 33.7%, P = 0.039). The quality of recovery, distance of 6-minute walk test, pain scores, and 36-item short form survey were comparable at each time points.
Conclusion: In patients undergoing video-assisted thoracic surgery, the use of balanced OFA anesthesia can help reduce the incidence of PONV events. This anesthetic regimen has shown good feasibility without significantly increasing the patient's pain score and complications.
Citation
Yan X, Liang C, Jiang J, Ji Y, Wu AS, Wei CW. Effects of balanced opioid-free anesthesia on post-operative nausea and vomiting in patients undergoing video-assisted thoracic surgery: a randomized trial. BMC Anesthesiol. 2025 Feb 8;25(1):62. doi: 10.1186/s12871-025-02938-x. PMID: 39923016; PMCID: PMC11806895.
