Efficacy of Opioid-Free Anesthesia in Reducing Postoperative Adverse Events for Thoracoscopic Pulmonary Surgery: A Randomized Controlled Trial

Abstract 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 hours postoperatively.Secondary outcomes included intraoperative events,pain scores,opioid consumption,time to first flatus/defecation,and cardiovascular complications. Results At 2 hours 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 hours,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 hours vs 11.4 ± 4.7 hours,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)