Opioid-free versus opioid-based anaesthesia and analgesia for patients at low risk for acute postoperative pain undergoing laparoscopic surgery : A randomised controlled trial
Mogianos, Krister LU
; Holgersson, Josefine
; Undén, Johan
LU
and Persson, Anna K M
LU
(2026)
In Journal of Clinical Anesthesia
108.
- Abstract
OBJECTIVE: To evaluate if opioid-free anaesthesia (OFA), is non-inferior to standard of care (SOC), in patients at low risk for acute postoperative pain (APOP).
DESIGN: Patient- and assessor-blinded, non-inferiority, randomised, controlled trial.
SETTING: Single centre between March 2022 to February 2024.
PATIENTS: 154 adult patients, ASA I - II, planned for elective laparoscopic surgery and risk-classified as low risk for APOP based on perceived pain during venous cannulation (VAS < 2.0).
INTERVENTION: Patients were randomised to receiving OFA, including sevoflurane, dexmedetomidine, esketamine and lidocaine, or standard of care (SOC), a traditional GABAA and opioid-based strategy. Patients were subjected to... (More)
OBJECTIVE: To evaluate if opioid-free anaesthesia (OFA), is non-inferior to standard of care (SOC), in patients at low risk for acute postoperative pain (APOP).
DESIGN: Patient- and assessor-blinded, non-inferiority, randomised, controlled trial.
SETTING: Single centre between March 2022 to February 2024.
PATIENTS: 154 adult patients, ASA I - II, planned for elective laparoscopic surgery and risk-classified as low risk for APOP based on perceived pain during venous cannulation (VAS < 2.0).
INTERVENTION: Patients were randomised to receiving OFA, including sevoflurane, dexmedetomidine, esketamine and lidocaine, or standard of care (SOC), a traditional GABAA and opioid-based strategy. Patients were subjected to the intervention from time to arrival at the day of surgery until discharge from the PACU.
MEASUREMENTS: Primary outcome: worst pain intensity in the PACU.
SECONDARY OUTCOMES: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.
RESULTS: Pain scores were 4.8 in the OFA group and 4.6 in SOC group (P = 0.67). At 24 h, worst pain at rest was 5.7 vs 5.0 (P = 0.11), and during movement 5.6 vs 5.3 (P = 0.43). Proportion of patients with NRS ≥ 4 in the PACU was 66 % vs 69 % (P = 0.65) and at 24 h 76 % vs 60 % at rest (P = 0.042) and 73 % vs 69 % during movement (P = 0.65). There was no significant difference in PPOP at 3 or 6 months, either at rest (P = 0.51, P = 0.56) or movement (P = 0.72, P = 0.48), PONV (PACU: P = 0.93), at 24 h: (P = 0.52) or postoperative recovery at 24 h (99 vs 102, P = 0.44). OFA group required less rescue opioids in the PACU (3.4 mg vs 5.1 mg, P = 0.039).
CONCLUSION: When individualising anaesthesia based on predicted risk for APOP, OFA is non-inferior to a traditional GABAA and opioid-based anaesthesia strategy, for patients with a low risk for APOP undergoing laparoscopic surgery. No secondary advantages, i.e. lower PONV, less PPOP, better quality of recovery, was associated with OFA.
(Less)
- author
- Mogianos, Krister
LU
; Holgersson, Josefine
; Undén, Johan
LU
and Persson, Anna K M
LU
- organization
- publishing date
- 2026
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Clinical Anesthesia
- volume
- 108
- article number
- 112058
- publisher
- Elsevier
- external identifiers
-
- pmid:41175775
- ISSN
- 1873-4529
- DOI
- 10.1016/j.jclinane.2025.112058
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.
- id
- ce9cccc8-8e84-499b-88f9-fafe0ab80f53
- date added to LUP
- 2025-11-03 08:29:46
- date last changed
- 2025-11-03 10:56:43
@article{ce9cccc8-8e84-499b-88f9-fafe0ab80f53,
abstract = {{<p>OBJECTIVE: To evaluate if opioid-free anaesthesia (OFA), is non-inferior to standard of care (SOC), in patients at low risk for acute postoperative pain (APOP).</p><p>DESIGN: Patient- and assessor-blinded, non-inferiority, randomised, controlled trial.</p><p>SETTING: Single centre between March 2022 to February 2024.</p><p>PATIENTS: 154 adult patients, ASA I - II, planned for elective laparoscopic surgery and risk-classified as low risk for APOP based on perceived pain during venous cannulation (VAS < 2.0).</p><p>INTERVENTION: Patients were randomised to receiving OFA, including sevoflurane, dexmedetomidine, esketamine and lidocaine, or standard of care (SOC), a traditional GABAA and opioid-based strategy. Patients were subjected to the intervention from time to arrival at the day of surgery until discharge from the PACU.</p><p>MEASUREMENTS: Primary outcome: worst pain intensity in the PACU.</p><p>SECONDARY OUTCOMES: worst pain, and proportion having NRS ≥ 4, at 24 h (during rest and movement), worst pain and proportion having NRS ≥ 1, at 3- and 6-months (during rest and movement), postoperative recovery at 24 h, PONV in the PACU and at 24 h. Rescue dose opioids in the PACU was an exploratory outcome.</p><p>RESULTS: Pain scores were 4.8 in the OFA group and 4.6 in SOC group (P = 0.67). At 24 h, worst pain at rest was 5.7 vs 5.0 (P = 0.11), and during movement 5.6 vs 5.3 (P = 0.43). Proportion of patients with NRS ≥ 4 in the PACU was 66 % vs 69 % (P = 0.65) and at 24 h 76 % vs 60 % at rest (P = 0.042) and 73 % vs 69 % during movement (P = 0.65). There was no significant difference in PPOP at 3 or 6 months, either at rest (P = 0.51, P = 0.56) or movement (P = 0.72, P = 0.48), PONV (PACU: P = 0.93), at 24 h: (P = 0.52) or postoperative recovery at 24 h (99 vs 102, P = 0.44). OFA group required less rescue opioids in the PACU (3.4 mg vs 5.1 mg, P = 0.039).</p><p>CONCLUSION: When individualising anaesthesia based on predicted risk for APOP, OFA is non-inferior to a traditional GABAA and opioid-based anaesthesia strategy, for patients with a low risk for APOP undergoing laparoscopic surgery. No secondary advantages, i.e. lower PONV, less PPOP, better quality of recovery, was associated with OFA.</p>}},
author = {{Mogianos, Krister and Holgersson, Josefine and Undén, Johan and Persson, Anna K M}},
issn = {{1873-4529}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Journal of Clinical Anesthesia}},
title = {{Opioid-free versus opioid-based anaesthesia and analgesia for patients at low risk for acute postoperative pain undergoing laparoscopic surgery : A randomised controlled trial}},
url = {{http://dx.doi.org/10.1016/j.jclinane.2025.112058}},
doi = {{10.1016/j.jclinane.2025.112058}},
volume = {{108}},
year = {{2026}},
}