Opioid-Free General Anesthesia with Dexmedetomidine-Esketamine-Lidocaine Versus Opioid-Based General Anesthesia with Sufentanil-Remifentanil for Breast Benign Patients Undergoing Lumpectomy
Authors: Qian Xiali , Yuan Hongmei , Zhao Lin , Feng Shanwu , Chen Yajie , Wang Xiang 
Published: September 2021

Abstract
Background: Opioid-free anesthesia (OFA) is being implemented in breast benign lumpectomy due to increased awareness of opioid adverse effects and the national opioid crisis. The objective of this study was to examine the effect of Dexmedetomidine-Esketamine-Lidocaine OFA technique in breast benign lumpectomy and assess its impact on subjective pain, intraoperative hemodynamic parameters, adverse events versus standard opioid-based technique (OA).Methods: In this prospective, randomized study, sixty breast benign patients, aging from 20 to 60 years with American Society of Anesthesiologists physical status I or II, were scheduled to undergo lumpectomy. The patients were randomized to receive either OFA (OFA group) or opioid-based (OA group) anesthesia. Dexmedetomidine-Esketamine-Lidocaine or Sufentanil-Remifentanil was administered for induction and maintenance in OFA group or OA group, respectively. Intravenous flurbiprofen axate 50 mg was administered 10 minutes before the end of surgery, and dezocine 5 mg was given to patient showing visual analog scale (VAS) pain score≥4 at any point of time for postoperative rescue analgesia in both groups. Intraoperative hemodynamic parameters at the time points of entering operating room (T0), immediately after induction of anesthesia (T1), immediately after intubation (T2), 1 minute after surgical incision (T3), 5 minutes after surgical incision (T4), and 10 minutes after surgical incision (T5), number of vasoactive drugs required, awakening time and recovery time of orientation, postoperative pain VAS at 2 h, 12 h, and 24 h after recovery, number of postoperative rescue dezocine analgesia required, and incidence of adverse events were recorded.Results: The mean arterial pressure and heart rate at T1, T2, T3, T4, T5 were significantly lower in OA group than OFA group. The incidences of application of rescue ephedrine (1 of 30 [3.3%] versus 12 of 30 [40%], P=0.001) and rescue atropine (2 of 30 [6.7%] versus 6 of 30 [20%], P=0.038) were significantly lower in OFA group compared with OA group. The pain VAS scores at 2 h, 12 h, and 24 h after surgery and number of rescuing dezocine analgesia required (0 of 30 [0%] versus 0 of 30 [0%]) had no statistically significant difference between the two groups. Postoperative nausea and vomiting (3 of 30 [10%] versus 16 of 30 [53%], P=0.001) and application of rescue ondansetron (1 of 30 [3.3%] versus 10 of 30 [33%], P=0.003) were both less in the OFA group compared to those in OA group. However, compared with OA group, patients in OFA group had more delayed awakening time ([7.27±2.85] min versus [4.47±1.11] min, P=0.000) and prolonged recovery time of orientation. ([11.97±3.19] min versus [6.93±1.17] min, P=0.000).Conclusions: The combination of Dexmedetomidine-Esketamine-Lidocaine OFA technique may be an alternative anesthesia for breast benign lumpectomy as better hemodynamic stability, lower incidence of postoperative nausea and vomiting, and adequate postoperative analgesia compared with OA, although longer awakening time and longer recovery time of orientation.Trial registration number: ChiCTR2100044230 (http://www.chictr.org.cn/)