Effects Of Opioid-free Anesthesia On Perioperative Depression And Sleep Quality In Patients Undergoing Gynecological Laparoscopic Surgery

Part 1 The study of clinical application of opioid-free anesthesia in patients undergoing gynecological laparoscopic surgeryObjective Enhanced Recovery After Surgery(ERAS)has been widely used in various surgical fields,including gynecological laparoscopic surgery.However,the advantages of Opioid-free anesthesia(OFA)under ERAS protocol in laparoscopic gynecological surgery remain unclear.The purpose of this study was to research the feasibility and effectiveness of opioid-free anesthesia and traditional Opioid-based anesthesia(OA)in laparoscopic gynecological surgery under ERAS protocol.Methods A total of 77 patients were selected for elective gynecological laparoscopic surgery in Hefei Hospital Affiliated to Anhui Medical University,and perioperative intervention was performed according to ERAS.Patients were randomly divided into opioid-free anesthesia group(group OFA)and opioid-based anesthesia group(group OA).In group OF A,dexmedetomidine was injected intravenously before induction until the end of surgery,and in group OA,normal saline was given in the same way.All patients received TIVA.Esketamine and sufentanil were administered as induction analgesics in group OFA and group OA,respectively.After induction,I-gel was intubated and ultrasound guided bilateral transversal abdominal muscle plane(TAP)block was performed.Dexmedetomidine,propofol and esketamine were used for anesthesia maintenance in group OFA.Propofol and remifentanil were used for anesthesia maintenance in group OA.VAS scores at T6(leaving PACU immediately),T7(12h after surgery),T8(24h after surgery),T9(36h after surgery),T10(48h after surgery)and number of postoperative rescue analgesia of two groups were recorded,area under the curve of VAS(AUCVAS)was calculated.Heart rate(HR)and mean arterial pressure(MAP)were recorded at T1(before anesthesia induction),T2(surgical incision immediately),T3(30min after surgical incision),T4(at the end of surgery),T5(awakening immediately).Recovery time and orientation time,the incidence of Postoperative Nausea and Vomiting(PONV)were recorded.Results1.There were no differences in clinical and demographic data between the two groups(P>0.05).2.There were no differences in AUCVAS between the two groups(group OFA,16.72 ±2.50,group OA,15.99 ± 2.72,P=0.223).3.No differences were found in VAS scores at T6～T10(P=0.193),the number of postoperative rescue analgesia was 7 in group OFA and 4 in group OA,respectively(χ2=0.866,P=0.352).4.The incidence of PONV 48 h after surgery in group OFA(10.1%)was lower than that in group OA(28.9%)significantly(x2=4.916,P=0.027).5.No statistical differences were found in MAP(F=1.592,P=0.211)and in HR(F=0.196,P=0.659)at T1～T5 between the two groups.6.Times of awakening in group OFA were longer than those of group OA(P=0.036),times of orientation recovery in group OFA were longer than those of group OA(P=0.033).Conclusions1.In gynecological laparoscopic surgery,OFA technique under ERAS protocol is non-inferior to OA technique in analgesic effect.2.Compared to OA,OFA have lower incidence of PONV.3.Compared to OA,the awakening and orientation recovery times of OFA were prolonged.4.OFA technique is feasible and effective in patients undergoing gynecological laparoscopic surgery.Part 2 Effects of opioid-free anesthesia on depression mood and sleep in perimenopausal patients undergoing gynecological laparoscopic surgeryObjective Perimenopausal women have a high incidence of depression and sleep disorders.Serious adverse mood and sleep disorders of such patients may increase postoperative complications and affect postoperative recovery during surgical period.How to improve perimenopausal patients’ mental and sleep conditions during perioperative period has become a problem in medical field.Application of opioid-free anesthesia in gynecological laparoscopic surgery has certain feasibility and effectiveness,but the studies on the effects of perioperative mood and sleep in perimenopausal patients are few and still unclear.The aim of this study was to investigate the effects of opioid-free anesthesia on perioperative depression and sleep quality as well as Brain-derived Neurotrophic Factor(BDNF)and inflammatory factors in perimenopause patients undergoing gynecological laparoscopic surgery.Methods A total of 98 perimenopausal patients were selected for elective laparoscopic gynecological surgery in Hefei Hospital Affiliated to Anhui Medical University,and perioperative intervention was performed according to ERAS.Patients were randomly divided into opioid-free anesthesia group(group OFA)and opioid-based anesthesia group(group OA).In group OF A,dexmedetomidine was injected intravenously from 10 min before anesthesia induction to the end of surgery,and in group OA,normal saline was given in the same way.All patients received TIVA,esketamine and sufentanil were administered as induction analgesics in group OFA and group OA,respectively.After induction,I-gel laryngeal mask was implanted and TAP block was performed.Dexmedetomidine,propofol and esketamine were used for anesthesia maintenance in group OFA.Propofol and remifentanil were used for anesthesia maintenance in group OA.Hamilton Depression Rating Scale(HDRS-17)scores were recorded at T0(1 day before surgery),T9(14 days after surgery),T10(1 month after surgery)between two groups.Pittsburgh Sleep Quality Index(PSQI)scores were recorded at T0(1 day before surgery)and T10(1 month after surgery)between two groups.Interleukin-6(IL-6),Interleukin-10(IL-10),Tumor necrosis factor-α(TNF-α)and BDNF at T1(entering operation room),T4(24 h after surgery),T7(72 h after surgery),and T8(5 days after surgery).PSQI scores were evaluated at T0(1 day before surgery)and T11(one month after surgery).VAS scores at T2(leaving PACU immediately),T3(12h after surgery),T4(24h after surgery),T5(36h after surgery),T6(48h after surgery)and T7(72h after surgery)between two groups were recorded,and AUCVAS was calculated.Results1.No differences were found in clinical and demographic data between two groups(P>0.05).2.No differences were found in HDRS-17 scores between two groups before surgery(P=0.585).Postoperative HDRS-17 scores were both lower than peroperative one in two groups(P<0.01),at the time of 14 days and 1 month after surgery,HDRS-17 scores were lower in group OFA(P=0.009,P=0.031).3.No significant differences were found in PSQI scores between two groups at T0 and T10(Z=-0.443,P=0.658.Z=-2.099,P=0.036),postoperative sleep quality in group OFA was higher.Compared with T0,PSQI scores at T10 in group OFA was significantly lower(Z=-3.219,P=0.001),the sleep quality of patients was improved after surgery.4.No differences were found in IL-6,IL-10 and TNF-α concentrations between two groups at each time point(F=2.272,P=0.135;F=0.890,P=0.348;F=0.005,P=0.943);at T7 and T8,BDNF concentrations were higher in group OFA(P=0.015,P=0.000).In intra-group comparison,no differences were found in BDNF concentrations between two groups at T1 and T4(P>0.05),BDNF at T7 and T8 were increased successively and higher than those at T1 and T4(P<0.01).5.BDNF at T8 were significantly negatively correlated with postoperative HDRS-17 and PSQI scores(r=-0.521,P<0.01;r=-0.538,P<0.01;r=-0.381,P<0.01);IL-6 concentrations at 5 days after surgery were significantly positively correlated with HDRS-17 scores at 14 days and 1 month after surgery and PSQI scores at 1 month after surgery(r=0.298,P=0.003;r=0.341,P=0.001;r=0.320,P=0.001);There was a significant positive correlations between TNF-α concentrations at 5 days after surgery and PSQI scores at 1 month after surgery(r=0.266,P<0.01);6.PSQI scores at 1 month after surgery was significantly positively correlated with HDRS-17 scores at 14 days and 1 month after surgery(r=0.572,P<0.01;r=0.741,P<0.01).7.The AUCVAS of OFA group and OA group were 19.35±1.65 and 19.17±1.86,respectively,no significant difference was found(P=0.613).Conclusions1.Opioid-free anesthesia can significantly improve depression mood and sleep quality of perimenopausal patients undergoing gynecological laparoscopic surgery,the reason may be related to the up-regulation of postoperative BDNF expression.2.There is a correlation between postoperative depression and sleep disorders in perimenopausal patients undergoing gynecological laparoscopic surgery,both of which are correlated with the expression levels of postoperative BDNF and inflammatory factors.