Balanced Opioid-Free Anesthesia on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial Protocol.

Opioid-free anesthesia (OFA) combining dexmedetomidine, esketamine, and sevoflurane is being compared with opioid-based anesthesia (OBA) using sufentanil and sevoflurane in a randomized trial of 180 adults undergoing video-assisted thoracoscopic surgery lung resection. The primary outcome is the incidence of chronic postsurgical pain at 3 months. Secondary outcomes include acute pain, pain at 1 and 6 months, opioid consumption, adverse events, and quality of recovery. The hypothesis is that OFA will lower chronic pain rates, reduce adverse events, and improve recovery.

Study at a glance

Abstract

Opioids are widely used for anesthesia and postoperative analgesia; however, their use is related to increased risks of untoward effects including hyperalgesia and chronic postsurgical pain (CPSP). We aim to compare opioid-free anesthesia (OFA) with opioid-based anesthesia (OBA) on the incidence of CPSP after video-assisted thoracoscopic surgery (VATS). This randomized controlled clinical trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Soochow University, Suzhou, China. A total of 180 adult patients undergoing VATS lung resection will be randomized to receive one of two balanced anesthesia regimens: OFA (dexmedetomidine, esketamine, and sevoflurane) or OBA (sufentanil and sevoflurane). A standardized multimodal analgesia comprises erector spinae plane block, intravenous flurbiprofen axetil, and patient-controlled sufentanil analgesia. The primary outcome is the incidence of CPSP at 3 months after surgery. Secondary outcomes include acute postoperative pain at rest and while coughing (at discharge from post-anesthesia care unit and 6, 24 and 48 hours after surgery), the incidences of postoperative pain at 1 month and 6 months, postoperative 24- and 48-hour sufentanil consumption, adverse events (postoperative nausea and vomiting, headache, dizziness, hallucination, and nightmare), length of post-anesthesia care unit and hospital stay, and the 15-item quality of recovery scores at 48 hours after surgery. We hypothesize that the OFA strategy would decrease the incidence of CPSP, reduce postoperative adverse events, and enhance quality of recovery following VATS procedures. Chinese Clinical Trial Registry (ChiCTR2400081099).