Opioid Sparing Effect of Opioid Free Anesthesia in Laparoscopic Gynecological Surgeries with ERAS Protocol

Nour El-din, Tawfik Mohamed; Ewieda, Tamer Mohamed Ahmed; Alaa, Khaled Mohamed

doi:https://doi.org/10.21608/aimj.2025.446660

Opioid Sparing Effect of Opioid Free Anesthesia in Laparoscopic Gynecological Surgeries with ERAS Protocol

Document Type : Original Article

Authors

¹ Professor of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

² MSc, Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

https://doi.org/10.21608/aimj.2025.446660

Abstract

Background: Laparoscopic gynecological surgery has surpassed open surgery as the preferred form of gynecological care due to its minimally invasive nature. Although the laparoscopic approach often results in less postoperative discomfort than the open approach, Twenty percent to forty percent of patients report moderate to severe discomfort following laparoscopic procedures. Laparoscopic gynecological procedures can benefit from opioid-free anesthesia and the ERAS protocol, which can optimize patient recovery by shortening hospital stays without increasing mortality or morbidity rates.
Aim and objectives: To evaluate the opioid sparing effect of opioid free anesthesia regarding pain control reflected on hemodynamics in laparoscopic gynecological surgeries, so we compare between opioid free anesthesia vs opioid based anesthesia.
Subjects and methods: This prospective randomized single-blind controlled study was carried out on 90 patients divided into two groups. Opioid anesthesia group (OA): the patients will receive fentanyl (2mcg/kg). Opioid free anesthesia group (OFA): which will receive IV Paracetamol (15mg/kg), dexamethasone (8mg) and loading dose of dexmedetomidine (1mcg/kg) followed by maintenance dose of dexmedetomidine (0.1-0.3 mcg/kg/hr), ketamine (0.3 mcg/kg/hr) and lidocaine (1.5 mg/kg/hr) until end of surgery.Both groups underwent elective laparoscopic gynecological surgeries admitted to Al-Azhar University Hospitals, Cairo, Egypt in the duration from Jun 2023 till January 2025.
Results: Opioid anesthesia (OA) patients needed more rescue fentanyl, and the overall amount of fentanyl was much higher than in the opioid free anesthesia (OFA) patients. Neither group showed a statistically significant difference in agitation score. Opioid anesthesia (OA) patients had a substantially greater risk of postoperative nausea, vomiting, and pruritus compared to opioid free anesthesia (OFA) patients.
Conclusion: In gynecological laparoscopic surgery following the ERAS protocol, opioid-free anesthesia using the ERAS protocol is a safe and effective way to manage pain.

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