Key result
Opioid-free anesthesia with dexmedetomidine, ketamine, and lidocaine resulted in similar 24-hour postoperative morphine consumption compared to fentanyl-based anesthesia, with lower early pain scores.
Why the study?
Posterior spinal fusion is one of the most painful surgical options for teenagers with idiopathic scoliosis, prompting evaluation of opioid-free anesthesia.
Does opioid-free anesthesia using dexmedetomidine, ketamine, and lidocaine improve postoperative analgesia in adolescent patients undergoing scoliosis surgery?
RCT (n=50)
Double-blind
randomized
Does opioid-free anesthesia using dexmedetomidine, ketamine, and lidocaine improve postoperative analgesia in adolescent patients undergoing scoliosis surgery?
Opioid-free anesthesia with dexmedetomidine, ketamine, and lidocaine provides adequate pain management and delays the need for rescue analgesia compared to fentanyl-based anesthesia in adolescents undergoing scoliosis surgery.
May support opioid-free multimodal anesthesia in adolescent scoliosis surgery to limit opioid exposure; extends RCT evidence for this combination beyond standard regimens.
Background Posterior spinal fusion treatment is one of the most painful options accessible to teenagers with idiopathic scoliosis.Objectives This study evaluated the opioid-sparing anesthesia analgesic effect using a combination of dexmedetomidine, ketamine and lidocaine versus opioid-based anesthesia (OBA) with fentanyl in adolescent patients undergoing scoliosis surgery.Methods This prospective, double-blinded, randomized study was conducted on 50 patients, American Society of Anesthesiologists (ASA) physical state I–II, scheduled for surgical correction of adolescent idiopathic scoliosis under general anesthesia. Patients were equally categorized into two groups: group I – opioid-free anesthesia (OFA) and group II – OBA. Intraoperative magnesium, total postoperative morphine consumption, time to first postoperative rescue analgesia and adverse effects were recorded.Results Total postoperative morphine consumption at 24 h was insignificantly different between groups. The proportion of patients requiring intraoperative magnesium was significantly higher in OBA (P < 0.001). Visual analog scale was only significant at 1 and 2 h which was significantly higher in group OBA than group OFA (P = 0.012 and < 0.001, respectively). Time to first postoperative rescue analgesia was significantly earlier in OBA than in OFA. Hemodynamic stability was insignificantly different between both groups. Bradycardia, postoperative nausea and vomiting and respiratory depression were insignificantly different between groups.Conclusions In adolescent patients ASA I-II undergoing scoliosis correction surgery, OFA with a combination of dexmedetomidine, ketamine and lidocaine could provide adequate intra- and postoperative pain management, which can obviate the use of intraoperative opioids minimizing the total postoperative opioid requirements compared to OBA using fentanyl.
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Elahwal et al. (2023) conducted an RCT in Adolescent idiopathic scoliosis (n=50). Opioid-free anesthesia (dexmedetomidine, ketamine, and lidocaine) vs. Opioid-based anesthesia (fentanyl) was evaluated on Total postoperative morphine consumption at 24 h. Opioid-free anesthesia with dexmedetomidine, ketamine, and lidocaine resulted in similar 24-hour postoperative morphine consumption compared to fentanyl-based anesthesia, with lower early pain scores.
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