Key result
Opioid-free anaesthesia with lidocaine significantly reduced the incidence of post-induction hypotension compared to general anaesthesia with sufentanil (15.56% vs 55.56%, P<0.001).
Why the study?
Most studies on opioid-free anaesthesia have focused on postoperative pain control and opioid consumption, leaving haemodynamic stability less examined.
Does opioid-free anaesthesia with lidocaine improve post-induction haemodynamic stability compared to general anaesthesia with sufentanil in patients undergoing elective hysteroscopy?
RCT (n=90)
Double-blind
computer-generated
No
Does opioid-free anaesthesia with lidocaine improve post-induction haemodynamic stability compared to general anaesthesia with sufentanil in patients undergoing elective hysteroscopy?
Absolute Event Rate: 15.56% vs 55.56%
p-value: p=<0.001
Opioid-free anaesthesia with lidocaine significantly reduces the incidence of post-induction hypotension and bradycardia compared to sufentanil-based general anaesthesia.
Opioid-free lidocaine anaesthesia may support haemodynamic stability in select surgeries; leaves open need for larger trials before practice change.
BACKGROUNDː Most studies on opioid-free anaesthesia have focused on postoperative pain control and opioid consumption, with less attention paid to haemodynamic stability. We aimed to determine whether opioid-free anaesthesia with lidocaine would provide better haemodynamic stability than general anaesthesia. METHODSː This single-centre, parallel-group, randomised, double-blind, controlled trial included patients aged 18–50 years (American Society of Anesthesiologists Physical Status classes I–II) who underwent elective hysteroscopy. Patients were randomised into group S (general anaesthesia with sufentanil) or group L (opioid-free anaesthesia with lidocaine). All patients underwent the same anaesthetic induction and maintenance protocols. The primary outcome was the incidence of hypotension. Secondary outcomes included changes in the mean arterial pressure at different timepoints after anaesthesia induction, the incidence of bradycardia, and the average dose of rescue metaraminol. Intraoperative cardiac and respiratory events were recorded as safety events. RESULTSː Opioid-free anaesthesia with lidocaine provided better post-induction haemodynamic stability than general anaesthesia. The incidence of hypotension in groups L and S was 15.56% (7/45) and 55.56% (25/45), respectively, and significant differences were observed in the changes in mean arterial pressure at T1, T2, T3, T4, and T5. The average dose of rescue metaraminol significantly differed between groups [mean (SD), 1.02 (2.96) mg vs. 4.21 (5.64) mg, P = 0.001]. The incidence of bradycardia significantly differed between groups [0% (0/45) vs. 44.44% (20/45), P < 0.001). No severe adverse effects were observed in any group. CONCLUSIONː Opioid-free anaesthesia with lidocaine provides better post-induction haemodynamic stability than general anaesthesia, without any major adverse events. TRIAL REGISTRATION: The trial was registered on January 15, 2022 in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/showprojen.aspx?proj=149386), registration number ChiCTR2200055623.(15/01/2022)
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Hu et al. (2023) conducted an RCT in Elective hysteroscopy (n=90). Opioid-free anaesthesia with lidocaine vs. General anaesthesia with sufentanil was evaluated on Incidence of hypotension during anaesthesia induction (MAP ≤ 65mmHg for 3 min) (p=<0.001). Opioid-free anaesthesia with lidocaine significantly reduced the incidence of post-induction hypotension compared to general anaesthesia with sufentanil (15.56% vs 55.56%, P<0.001).
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