Effect of opioid sparing strategies on postoperative pain and perioperative hemodynamics in patients undergoing laparoscopic cholecystectomy: a randomized controlled study.

Background: Opioid-sparing anesthesia(OSA) or opioid-free anesthesia(OFA) strategy can reduce postoperative pain, but the effect of different stratigies on postoperative pain for patients with high pain sensitivity remains unclear, and the effect of different stratigies on perioperative haemodynamic fluctuations remains controversial for patients undergoing laparoscopic cholecystectomy.

Methods: A total of 173 patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups: opioid-free anesthesia group(Group OFA), opioid-sparing anesthesia group(Group OSA) or opioid-based anesthesia group (Group OBA). The preoperative assessment of patients' pain sensitivity was conducted using the Pain Sensitivity Questionnaire (PSQ). The visual analog scale (VAS) scores were recorded at 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h postoperatively. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at baseline(T0), after admission (T1), after induction(T2), 1 min after tracheal intubation (T3), 1 min after pneumoperitoneum (T4), and calculated as the variability of blood pressure (BPV), coefficient of variation (CV) and average real variability (ARV). Time to awake, acute pain, rescue analgesia, postoperative nausea and vomiting (PONV), and time to first exhaust were also recorded.

Results: Compared with Group OBA, VAS scores were significantly lower in Group OFA and OSA at 2 h, 6 h and 12 h postoperatively (P < 0.05). BPV_SBP, BPV_DBP, BPV_MAP, CV_SBP, CV_DBP, CV_MAP, ARV_DBP and ARV_MAP were lower in both Group OSA and OBA compared to the Group OFA (P < 0.05). Group OSA exhibited lower BPV_SBP, CV_DBP, and ARV_DBP compared to the OBA group (P < 0.05). In the subgroup analysis of patients with high pain sensitivity, BPV_SBP, BPV_DBP, BPV_MAP, CV_DBP, CV_MAP, ARV_SBP, ARV_DBP and ARV_MAP were lower in Group OSA compared to Group OFA (P < 0.05). BPV_DBP, CV_DBP, ARV_SBP and ARV_DBP were lower in the OSA group compared to the OBA group (P < 0.05). The time to first exhaust was significantly reduced in patients in Group OFA compared with Group OSA and OBA (P < 0.05).

Conclusion: OSA can effectively control patients' postoperative pain with lower perioperative haemodynamic variability. It also has lower perioperative haemodynamic variability and acute pain in patients with high pain sensitivity, making it suitable for laparoscopic cholecystectomy.

Trial registration: The trial is registered with the China Clinical Trials Registry Registration Number: ChiCTR2400093036. Retrospectively registered (date of registration: 27/11/2024).