Opioid-Free Anesthesia In Endoscopic Sinus Surgery With The Pain/Nociception Index Monitoring

Objectives: Whether opioid-free anesthesia(OFA)is consistently effective for different types of surgery and patients and whether OFA can effectively inhibit intraoperative nociception remain to be determined.The present study hypothesized that in endoscopic sinus surgery OFA can effectively inhibit the intraoperative nociceptive response,reduce the side effects associated with opioid use,and improve the quality of postoperative recovery.Methods: This is a prospective multicenter randomized controlled study.800 patients who undergoing endoscopic sinus surgery were randomly assigned to OA group(traditional anesthesia group)or OFA group(opioid-free anesthesia).All patients were fasted and abstained from drinking routinely and did not make any medicine before inducing.After entering the operating room,every patient’s vein channels were routinely established and vital signs were monitored,including electrocardiogram(ECG),blood pressure,pulse oxygen,BIS and q NOX.Patients received general anesthesia,OFA group was given dexmedetomidine,lidocaine,sevoflurane,and propofol balanced anesthesia,while OA group was given opioids(sufentanil,remifentanil),sevoflurane,and propofol balanced anesthesia,and muscle relaxants were used intermittently during surgery.Hemodynamics(mean arterial pressure,heart rate),BIS,q NOX and the need for vasoactive drugs during the surgery were recorded,as well as extubation time,PACU discharge time,pain score and the use of analgesics were recorded.Qo R-40 questionnaire was used to evaluate the quality of recovery 24 hours after surgery,and observe the incidence of nausea and vomiting(PONV)within 24 hours after surgery.Concluding all sets of data and statistical analysis to get experimental results.Results: The demographic characteristics of the two study groups were comparable.The intraoperative BIS and q NOX values were within target range for both groups;but the values were significantly lower in the OFA group.There was no significant difference in the total score of 24-hour postoperative Qo R-40(190.3 ± 10.6 vs.189.4 ± 9.0;P =0.219).Within 24 hours after the operation,the VAS pain scores of the OFA group were lower than those of the OA group(P<0.05),and there was nonsignificant difference in use of rescue analgesics between the OFA group and the OA group(36 [9.3%] vs.53 [13.7%];P=0.056).There was no significant difference in extubation time between groups,compared with OA group,patients in OFA group had significantly longer PACU discharge time.The incidence of postoperative nausea and vomiting in OFA group was significantly lower than that in OA group,and the difference was statistically significant(P<0.05).Conclusions: This study shows that OFA can provide an intraoperative analgesia-nociception balance and a postoperative recovery quality as effectively as the conventional OA in patients undergoing endoscopic sinus surgery.The OFA can reduce postoperative nausea and vomiting,but extended the PACU discharge time,Therefore,further investigation is needed to determine the benefit-risk ratio between OFA and OA.