Clinical Study Of Opioid-free Anesthesia In Unilateral Biportal Endoscopy In Spinal Surgery

Objective:To explore the feasibility of opioid-free anesthesia in unilateral biportal endoscopy in spinal surgery,and to assess the effect of opioid-free anesthesia on postoperative pain,postoperative waking duration,and the extent of postoperative nausea and vomiting.Methods:This trial was selected from hospitalization in spinal surgery of our hospital from January 2021 to December 2021.Subjects were 60patients planning to receive unilateral biportal endoscopy surgery under general anesthesia,and the collected cases were randomly divided into two groups,opioid-free group（group A）and opioid group（group S）,30cases in each group。In group A,an epidural puncture was performed adjacent to the procedure before induction.Epidural cavity injection of7.5 ml of 2%lidocaine+7.5 ml of 1%ropivacaine mixture after no adverse reactions.After testing the anesthesia plane,anesthesia induction was performed using propofol 2 mg·kg^-1,rocuronium 0.6 mg·kg^-1,and esmolol 1.5 mg·kg^-1.No epidural puncture was performed in group S,and anesthesia induction was performed using propofol 2 mg·kg^-1,rocuronium0.6 mg·kg^-1,and sulfentanil 0.5ug·kg^-1.Group A maintained the depth of anesthesia using dexmetomidine 0.2 ug·kg^-1·h^-1and propofol 4mg·kg^-1·h^-1,and group S maintained the depth of anesthesia using dexmetomidine0.2ug·kg^-1·h^-1and propofol 4mg·kg^-1·h^-1,and sufentanil 0.2ug·kg^-1was used when cutting the skin.Additional rocuronium 0.1mg·kg^-1was used every 40 minutes in two groups.Some metrics of two groups were recorded,including the Visual Analogue Score before surgery（Ta）,after extubation（Tb）,12h after surgery（Tc）,and 24h after surgery（Td）;hemodynamic indicators such as heart rate,blood pressure at each time point immediately after entry（T0）,induction（T1）,intubation completion（T2）,3 minutes after intubation（T3）and cutting the skin（T4）;postoperative extubation time;nausea and vomiting score after extubation and 24h postoperative procedure;postoperative hospitalization duration.Results:Patients in both groups had similar clinical characteristics（P>0.05）;the Visual Analogue Score in the moment of Tb（after extubation）was significantly lower in group A,compared to the group S（P<0.05）,and there was no statistically significant difference between the Visual Analogue Score of two groups at other times;the HR in the moment of T2（intubation completion）was significantly lower in group A,compared to the group S（P<0.05）,and there was no statistically significant difference between the HR of two groups at other times;the MAP in the moment of T4（cutting the skin）was significantly lower in group A,compared to the group S（P<0.05）,and there was no statistically significant difference between the MAP of two groups at other times;the postoperative tube time was significantly lower in group A,compared to the group S（P<0.05）;the score of nausea and vomiting after extubation was significantly lower in group A,compared to the group S（P<0.05）,and the score of the nausea and vomiting at 24h after surgery was significantly lower in group A,compared to the group S（P<0.05）;there was no significant difference between the postoperative hospitalization duration in group A and group S（P>0.05）.Conclusion:Opioid-free general anesthesia is safe and feasible in unilateral biportal endoscopy in spinal surgery,and it has certain advantages in postoperative analgesia,reducing postoperative nausea and vomiting,and shortening the extubation time.