Background In view of analgesia and hemodynamic control in cranial surgeries, opioids have been used for decades. However, the use of opioids is not devoid of side effects. The current study was designed to evaluate opioid‐free anesthesia (OFA) as an alternative to opioid anesthesia (OA) in cranial surgeries for supratentorial tumors. Methods Sixty patients undergoing supratentorial tumor excision were randomized between two arms to receive either OA or OFA. Patients in the OFA arm received a bolus of several nonopioid adjuvants, including dexmedetomidine, ketamine, magnesium sulfate, and lidocaine, followed by infusion of dexmedetomidine, lidocaine, and ketamine. Patients in the OA group received fentanyl. The primary endpoint was the percentage of patients experiencing hemodynamic instability (> 25% deviation from baseline mean arterial pressure MAP at burr hole). Other parameters included hemodynamics at other stressful points, brain relaxation score, and recovery profile. Results All patients completed the study. Both arms were comparable with respect to the percentage experiencing hemodynamic instability at burr hole. 13% in the OFA arm experienced instability versus 23.3% in the OA group ( p value = 0.317). However, MAP was better maintained in the OFA arm at burr hole ( p value = 0.028), at other stressful points, and in the early postoperative period. Brain relaxation score was comparable between both arms, while the recovery profile was favorable in the OFA group in the early postoperative period. Conclusion OFA is a good alternative to OA in cranial surgeries with adequate hemodynamics at burr hole and other stressful points and better recovery allowing early neurological assessment. Trial Registration: Clinical trial.gov.identifierNCT04941040.
Fahmy et al. (Thu,) studied this question.