Comparison of opioid-free versus weak-opioid general anesthesia on quality of postoperative recovery in soldiers undergoing arthroscopic meniscal surgery

Objective To determine whether opioid-free anesthesia improves early postoperative recovery compared with weak-opioid anesthesia in soldiers undergoing meniscal surgery for training-related injuries. Method A total of 100 patients scheduled for elective meniscal surgery were randomized into two groups ( n = 50 each): weak-opioid anesthesia group (WOA) and opioid-free anesthesia (OFA) group. Anesthesia induction consisted of alfentanil 0.2 μg/kg in the WOA group and esketamine 0.2 mg/kg in the OFA group. Intraoperatively, the OFA group received esketamine 0.2 mg/kg/h, lidocaine 1 mg/kg/h, and sevoflurane (MAC 1.0–1.4). The WOA group received remifentanil 0.1 μg/kg/h and sevoflurane (MAC 0.8–1.0). The primary endpoint was the QoR15 score at 24 h postoperatively. Results The OFA group achieved significantly higher QoR15 scores at 24, 48, and 72 h, with the 24-h difference exceeding the threshold for clinical significance. The OFA group was associated with longer awakening times but earlier return of gastrointestinal function (shorter time of flatus). Intraoperatively, the WOA group experienced greater reductions in heart rate and mean arterial pressure, with a higher incidence of remarkable bradycardia. Postoperatively, the OFA group reported lower NPRS scores across the first 3 days, required less rescue analgesia, and had a lower incidence of rebound pain. Conclusion Compared with weak-opioid anesthesia, opioid-free anesthesia significantly improves early postoperative recovery quality, as measured by the QoR15, in soldiers undergoing arthroscopic meniscal surgery.