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Background <p>This study compared the effects of opiate-free anesthesia (OFA) using thoracic paravertebral block combined with dexmedetomidine versus traditional anesthesia with sufentanil and remifentanil on postoperative adverse reactions after thoracoscopic lung surgery.</p> Methods <p>A prospective, randomized, double-blind trial included 97 patients(49 in OFA group,48 in S group).All received preoperative thoracic paravertebral block.The primary outcome was the incidence of opioid-related adverse reactions (hypoxemia, hypotension, nausea, vomiting, dizziness) at 2,4,6,24,and 48&#xa0;h postoperatively.Secondary outcomes included intraoperative events, pain scores, opioid consumption, time to first flatus/defecation, and cardiovascular complications.</p> Results <p>At 2&#xa0;h postoperatively, hypotension incidence was lower in the OFA group(8.2%vs 33.3%,<i>P</i> = 0.002),with fewer overall adverse reactions (18.4%vs 39.6%,<i>P</i> = 0.018).At 24&#xa0;h, PONV was 0%in OFA vs. 10.4%in S group(<i>P</i> = 0.027),dizziness was 8.2%vs 22.9%(<i>P</i> = 0.041),and overall adverse reactions were 10.2%vs 27.1%(<i>P</i> = 0.029).OFA had fewer vasopressor applications (<i>P</i> &lt; 0.001), lower 24-hour opioid use (<i>P</i> = 0.033), fewer analgesic pump presses(<i>P</i> = 0.004),and earlier first feeding (9.5 ± 3.8&#xa0;h vs. 11.4 ± 4.7&#xa0;h, <i>P</i> = 0.035).</p> Conclusion <p>OFA significantly reduced opioid-related adverse reactions, decreased vasopressor and opioid use, and improved recovery.However, the single-center, small-sample design limits generalizability, and multicenter validation is needed.</p> Trial registration <p>This randomized controlled trial was registered on clinicaltrials.gov (ID: NCT04507165; URL: <a href="https://clinicaltrials.gov/study/NCT04507165">https://clinicaltrials.gov/study/NCT04507165</a>, 11/08/2020).</p>

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Efficacy of opioid-free anesthesia in reducing postoperative adverse events for thoracoscopic pulmonary surgery: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月12日

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  • Ran Zhang,
  • Yaqing Wu,
  • Xiaoyi Wang,
  • Weixin Zhang,
  • Yi Feng

摘要

Background

This study compared the effects of opiate-free anesthesia (OFA) using thoracic paravertebral block combined with dexmedetomidine versus traditional anesthesia with sufentanil and remifentanil on postoperative adverse reactions after thoracoscopic lung surgery.

Methods

A prospective, randomized, double-blind trial included 97 patients(49 in OFA group,48 in S group).All received preoperative thoracic paravertebral block.The primary outcome was the incidence of opioid-related adverse reactions (hypoxemia, hypotension, nausea, vomiting, dizziness) at 2,4,6,24,and 48 h postoperatively.Secondary outcomes included intraoperative events, pain scores, opioid consumption, time to first flatus/defecation, and cardiovascular complications.

Results

At 2 h postoperatively, hypotension incidence was lower in the OFA group(8.2%vs 33.3%,P = 0.002),with fewer overall adverse reactions (18.4%vs 39.6%,P = 0.018).At 24 h, PONV was 0%in OFA vs. 10.4%in S group(P = 0.027),dizziness was 8.2%vs 22.9%(P = 0.041),and overall adverse reactions were 10.2%vs 27.1%(P = 0.029).OFA had fewer vasopressor applications (P < 0.001), lower 24-hour opioid use (P = 0.033), fewer analgesic pump presses(P = 0.004),and earlier first feeding (9.5 ± 3.8 h vs. 11.4 ± 4.7 h, P = 0.035).

Conclusion

OFA significantly reduced opioid-related adverse reactions, decreased vasopressor and opioid use, and improved recovery.However, the single-center, small-sample design limits generalizability, and multicenter validation is needed.

Trial registration

This randomized controlled trial was registered on clinicaltrials.gov (ID: NCT04507165; URL: https://clinicaltrials.gov/study/NCT04507165, 11/08/2020).