Evaluation of opioid-free anaesthesia in curtailing postoperative serum levels of inflammatory markers and providing post-operative analgesia in open abdominal hysterectomies—a prospective comparative study.

Abstract

BACKGROUND:

AIM:

To Demonstrate the efficacy of dexmedetomidine in reducing the effects of post-operative inflammatory responses in patients receiving general anesthesia with opioids and general anesthesia without opioids but with Dexmedetomidine for open-abdominal hysterectomy.

OBJECTIVES:

1: To compare the serum levels of postoperative inflammatory markers in patients receiving anaesthesia by the two different anaesthetic procedures. 2: To compare pain score and duration of postoperative analgesia in the two groups. 3: To compare the incidence of postoperative nausea and vomiting.

METHODOLOGY: - Written informed consent taken - Nil by mouth status was confirmed. - IV access was secured with a 20G cannula. - Patients underwent a thorough pre-anaesthetic evaluation with a detailed history, systemic evaluation, and airway examination. The patient was given a thorough walk-through of the anaesthetic procedure to be performed and explained the numeric rating scale. A complete blood panel workup was done along with preoperative inflammatory serum markers. 10 Docusign Envelope ID: 4A7FD7EE-5F58-498D-B6D4-7D0B286B4C8B Docusign Envelope ID: 4A7FD7EE-5F58-498D-B6D4-7D0B286B4C8B RESULTS ● The perioperative inflammatory process was affected by the choice of anaesthetic agent used. This study aimed to evaluate the efficacy of Dexmedetomidine as a substitute for opioids, which are routinely used. ● When opioids were used, the postoperative inflammatory markers were found to be significantly higher as compared to preoperative values of the same. ● Results showed that there were minimum variations in the haemodynamic parameters in the opioid-free group when compared to the opioid-based group. ● In the 24-hours after surgery, patients in the opioid-free group reported lower pain scores and required lesser rescue analgesia compared to those receiving opioid, who submitted more requests for additional pain relief. ● It was also found that the MAC for inhalational agents was significantly reduced in the OF-GA group (MAC 0.6-0.4 of isoflurane). ● Several studies have found that Dexmedetomidine is a very good analgesic and a good anxiolytic agent. Studies have also found that perioperative stress, inflammatory responses, PONV, and cognitive dysfunctions were lessened when dexmedetomidine was used. CONCLUSIONS Intraoperative dexmedetomidine-based analgesia resulted in longer postoperative analgesia with a lesser requirement of rescue analgesia, decreased episodes of nausea and vomiting, and better control over the inflammatory markers induced by surgery.