The feasibility analysis of opioid-free general anesthesia with dexmedetomidine- esketamine-lidocaine for patients undergoing lumpectomy
Authors: Qian Xia-li , Yuan Hong-mei , Zhao Lin , Chen Ya-jie , Wang Xian , Feng Shan-wu 
Published: September 2022

Abstract
Background: Opioid-free anesthesia (OFA) is increasing being explored due to increased awareness of opioid related adverse events and the national opioid crisis. The objective of this study was to examine the feasibility of Dexmedetomidine-Esketamine-Lidocaine OFA technique for patients diagnosed with breast begin mass underwent Lumpectomy, especially paying attention to its impact on postoperative pain, intraoperative hemodynamic parameters, recovery quality, and adverse events.
Methods: In this prospective, randomized study, sixty patients who aged from 20 to 60 years, graded with American Society of Anesthesiologists physical status I or II, diagnosed with breast begin mass and scheduled to undergo Lumpectomy were enrolled. These 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. Postoperative visual analog scale (VAS) pain score at 2 h, 12 h, and 24 h after extubation was recorded. Intraoperative hemodynamic parameters were recorded at the following time points: 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 rescue analgesics used, rescue vasoactive drugs required, awakening time and recovery time of orientation, and incidence of adverse events were recorded as well.
Results: The VAS score at 2, 12, and 24 h after extubation and number of rescue hydromorphone required (0 of 30 [0%] versus 0 of 30 [0%]) had no statistically significant difference between the two groups. The mean arterial pressure and heart rate at T1, T2, T3, T4, T5 were significantly lower in OA group than that in OFA group. The number 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. 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 a longer awakening time ([7.27±2.85] min versus [4.47±1.11] min, P=0.000), longer recovery time of orientation ([11.97±3.19] min versus [6.93±1.17] min, P=0.000), higher analgesia-related drug cost ([$23.89±4.20] versus [ $21.31±3.94], P=0.017).
Conclusions: The combination of Dexmedetomidine-Esketamine-Lidocaine OFA technique may be an alternative anesthesia for lumpectomy as better hemodynamic stability, lower incidence of postoperative nausea and vomiting, and adequate postoperative analgesia compared with OBA. But the traditional OA technique has shorter awakening time, shorter recovery time of orientation and lower analgesia-related cost.