Opioid-sparing anaesthesia protocol on gastrointestinal function after benign gynaecological laparoscopic surgery: a prospective randomized controlled double-blind study

Background : Gastrointestinal hypokinesis can occur transiently after benign gynecologic surgery. Opioids cause the side effect of postoperative gastrointestinal hypokinesis, but an opioid-sparing anaesthetic protocol based on esketamine reduces intraoperative opioid consumption. Therefore, this study hypothesised that an opioid-sparing anaesthetic protocol based on esketamine would shorten the gastrointestinal function recovery time after benign gynaecological laparoscopic surgery. Methods : This was a prospective randomized controlled double-blind study conducted in a single centre. All patients scheduled for elective benign laparoscopic gynaecological surgery at Xing'an Meng People's Hospital, Inner Mongolia Autonomous Region, from November 2021 to April 2022 were consecutively enrolled and randomly divided into the opioid-sparing anaesthesia group (Group OS) and the conventional anaesthesia group (Group C). Postoperative first exhaust time, feeding time and postoperative nausea and/or vomiting (PONV) were observed in both groups. Results : A total of 71 patients were enrolled in this study, including 35 in Group OS and 36 in Group C. The general condition, operative time, type of surgery, intraoperative bleeding, intraoperative fluid volume and intraoperative urine volume were not statistically different between the two groups. Compared with Group C, significantly shorter anaesthesia resuscitation time (7 [6,9] h vs. 9 [7,11] h, p = 0.013) and first postoperative exhaustion time (11 [8,14] h vs. 14 [11,18], p = 0.003) were observed in the OS group. The incidence of PONV in Group OS was significantly lower compared with Group C (11.4% vs. 41.7%, p = 0.007). Conclusion : The esketamine-based opioid-sparing anaesthesia protocol may shorten gastrointestinal function recovery time, reduce the incidence of PONV, and promote early recovery in patients after benign gynaecological laparoscopic surgery. Also, the application of esketamine may reduce the postoperative opioid dosage requirement of patients. Trial registration : This study was registered with the China Clinical Trials Registry (registration number: ChiCTR2100052528, 30/10/2021)