EFFICACY OF MULTIMODAL OPIOID-FREE ANESTHESIA ON POSTOPERATIVE RECOVERY PROFILES AND HYPERALGESIA FOLLOWING MAJOR ABDOMINAL SURGERIES
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Abstract
Background: Opioid-free anaesthesia (OFA) has emerged as an alternative anaesthetic strategy to minimise opioid-related adverse effects while enhancing postoperative recovery. This study evaluated the efficacy of multimodal OFA in improving recovery profiles and reducing postoperative hyperalgesia among patients undergoing major abdominal surgeries. Methods: A prospective comparative study was conducted on 100 adult patients (18–65 years, ASA physical status I–II) scheduled for elective major abdominal surgeries. Patients were equally allocated into two groups: Group O (Conventional Opioid-Based Anaesthesia, n=50) and Group OFA (Multimodal Opioid-Free Anaesthesia, n=50). The OFA protocol included dexmedetomidine, ketamine, lidocaine infusion, paracetamol, and NSAIDs, whereas the conventional group received fentanyl-based anaesthesia. Primary outcomes included Quality of Recovery-15 (QoR-15) score at 24 hours and postoperative hyperalgesia assessed using the Numeric Rating Scale (NRS). Secondary outcomes included opioid consumption, postoperative nausea and vomiting (PONV), time to ambulation, and length of hospital stay. Results: Group OFA demonstrated significantly higher QoR-15 scores (131.8 ± 9.4 vs. 118.6 ± 11.2; p<0.001) and lower postoperative hyperalgesia scores at 24 hours (2.1 ± 1.0 vs. 4.3 ± 1.4; p<0.001) compared with Group O. Mean postoperative morphine-equivalent consumption was reduced by 62% in the OFA group (8.5 ± 3.1 mg vs. 22.4 ± 5.8 mg; p<0.001). The incidence of PONV was significantly lower (14% vs. 38%; p=0.008), and patients achieved earlier ambulation (16.8 ± 4.3 vs. 22.5 ± 5.7 hours; p<0.001). Hospital stay was modestly shorter in the OFA group (4.2 ± 0.9 vs. 5.1 ± 1.2 days; p=0.003). Conclusion: Multimodal opioid-free anesthesia significantly improves postoperative recovery, reduces opioid requirements and hyperalgesia, and decreases opioid-related complications following major abdominal surgeries. Incorporating OFA into enhanced recovery protocols may improve perioperative outcomes and patient satisfaction while supporting opioid-sparing perioperative care. Keywords: Opioid-free anesthesia, Multimodal analgesia, Hyperalgesia, Major abdominal surgery, Enhanced recovery, Postoperative pain, QoR-15.
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Dr. Faeiz Khan
Assistant Professor, Department of Anesthesiology, KD Medical College, Mathura, Uttar Pradesh, India
Dr. Pranay Gupta
Senior Resident, Department of Emergency Medicine and Critical Care, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
Dr Shiva Dwivedi
Assistant professor, Department of Anesthesiology, LNCT Medical College & Sewakunj Hospital Indore, MP
