691: Opioid-Free vs Opioid-Based Anesthesia for Postoperative Analgesia in Laparoscopic Urologic Surgery

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Acute postsurgical pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Drug development

Background and Aims: Recent advances in genitourinary surgery have transitioned from open procedures to minimally invasive laparoscopic techniques, enhancing visualization and minimizing tissue trauma. Although considered less painful, laparoscopic urological surgeries can still result in mild-to-moderate postoperative pain. Effective pain management is therefore essential, especially for elderly patients who are more susceptible to perioperative complications. Opioids have traditionally been used for postoperative analgesia but are linked to adverse effects such as respiratory depression, sedation, nausea, and dependence. [1,2] ERAS protocols recommend minimizing opioid use. [3] Opioid-free anesthesia, using multimodal non-opioid analgesics, provides effective pain control and may enhance postoperative recovery outcomes.

Methods: This prospective randomized study compared opioid-based (fentanyl) and opioid-free (dexmedetomidine) anesthesia in 70 patients undergoing laparoscopic urological surgery.The OF group received dexmedetomidine (loading dose 1 μg/kg over 10 minutes, maintenance 0.5 μg/kg/h), while the OB group received fentanyl in equivalent dosing. Both groups received standard anesthesia and bilateral TAP block with bupivacaine. Postoperative pain was assessed using the Visual Analog Scale at predefined intervals up to 24 hours. The primary outcome measured was VAS at rest at 1 hour, while secondary outcomes included VAS during coughing, rescue analgesia requirement, total tramadol consumption, and adverse events.

Results: The VAS-R score at 1 hour postoperatively was significantly lower in the opioid-free (OF) group compared to the opioid-based (OB) group, with a mean difference of 0.20 ± 0.41 (p < 0.005). At 24 hours, VAS-C scores remained significantly lower in the OF group (p = 0.031). The requirement for rescue analgesia and adverse events was significantly reduced in the OF group as compared to the OB group (p < 0.001 & p = 0.002). Total tramadol consumption was also significantly lower in the OF group at both 6 hours and 24 hours postoperatively (p < 0.001 and p = 0.013, respectively).

Conclusions: With the increasing use of laparoscopic techniques in urological surgeries, effective postoperative pain management is vital for enhancing recovery and reducing complications. This randomized controlled study compared opioid-based and opioid-free anesthesia for postoperative analgesia. Opioid-free anesthesia demonstrated superior pain control, with significantly lower resting pain scores at 1 hour. Dynamic pain during coughing was also consistently lower in the opioid-free group. Additionally, patients receiving opioid-free anesthesia required less rescue analgesia and had reduced total analgesic consumption within 24 hours. These findings suggest that opioid-free anesthesia offers effective and safer postoperative pain management in laparoscopic urological surgeries.

References: 1. Garimella V, Cellini C. Postoperative Pain Control.Clin Colon Rectal Surg2013; 26(3): 191–6.
2. Del Vecchio G, Spahn V, Stein C. Novel Opioid Analgesics and Side Effects. ACS Chem Neurosci2017;8(8):1638–40.
3. Nelson G, Bakkum-Gamez J, Kalogera E,Glaser G, Altman A, Meyer LA, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After
Surgery (ERAS) Society recommendations—2019 update. Int J Gynecol Cancer Cancer2019;29(4):651–68.

Presenting Author: Shradha Prasad
Submitting Author: Shradha Prasad

Senior Author: Shipra Aggarwal

IASP 2026 Global Year theme of Neuropathic Pain: No

• Shipra Aggarwal: MD, DNB - Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India