Opioid-free Anaesthesia for Partial Sacrectomy: A Multimodal Approach in a High-risk Surgery: A Case Report

Sacral chordoma is a rare malignant tumour requiring extensive surgical resection, often necessitating total sacrectomy. These procedures pose major anaesthetic challenges due to significant blood loss, haemodynamic instability and the need for effective perioperative analgesia. Conventional opioid-based anaesthesia can exacerbate postoperative morbidity, including gastrointestinal dysfunction, respiratory compromise and delayed recovery. We describe the perioperative management of a patient undergoing total sacrectomy using an opioid-free anaesthesia strategy within an enhanced recovery after surgery framework. The multimodal regimen incorporated lumbar epidural analgesia, dexmedetomidine infusion and regional nerve blocks, supplemented with non-opioid systemic agents for analgesia and haemodynamic control. This approach maintained intraoperative stability, ensured adequate analgesia without any opioid exposure and supported early postoperative recovery.