Comparative Study of Efficacy of Preemptive Use of Opioid-free Anesthesia Using Paracetamol, Magnesium Sulfate, Lignocaine, Dexamethasone versus Intravenous Fentanyl for Attenuating Hemodynamic Response, Perioperative Analgesia, and Postoperative Recovery Profile during Laparoscopic Cholecystectomy:

Background

Opioids such as fentanyl are widely used in general anesthesia for intraoperative analgesia; however, their use is associated with adverse effects, including respiratory depression, postoperative nausea and vomiting (PONV), ileus, and risk of opioid-related hyperalgesia. Opioid-free anesthesia (OFA) has emerged as an alternative approach utilizing nonopioid agents to provide adequate analgesia while minimizing opioid-related complications. This study aimed to compare the efficacy and safety of OFA with fentanyl-based anesthesia in patients undergoing laparoscopic cholecystectomy.

Materials And Methods

This prospective, randomized study included 60 American Society of Anesthesiologists I-II patients undergoing elective laparoscopic cholecystectomy, allocated into two groups (n = 30 each). Group P received OFA with intravenous paracetamol, magnesium sulfate, lignocaine, and dexamethasone while Group F received fentanyl-based anesthesia. Hemodynamic parameters were recorded intraoperatively. Postoperative pain (Numerical Rating Scale), time to first analgesic request, total analgesic consumption, and incidence of PONV were assessed. Data were analyzed using Student's t-test and Chi-square test, with P < 0.05 considered statistically significant.

Results

The study included 60 patients (30 per group) and demonstrated comparable outcomes between groups. Transient intraoperative differences were noted in heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure, but overall stability was similar. Time to first analgesic was shorter in OFA (119.20 ± 62.30 vs. 154.57 ± 53.04 min, P = 0.021). Total analgesic consumption and PONV incidence were comparable, indicating equivalent efficacy and safety.

Conclusions

OFA provides effective intraoperative analgesia with improved postoperative outcomes. OFA represents a safe and viable alternative to fentanyl-based anesthesia in laparoscopic cholecystectomy.