Comparison of opioid-free versus opioid-based total intravenous anaesthesia in elderly patients undergoing short-duration surgery: a randomized controlled trial.
Shirong Wei, Sitong Zhou, Junwen Tu et al.
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In 30 seconds
This single-centre randomized controlled trial in China compared opioid-free total intravenous anaesthesia (OFA) with opioid-based total intravenous anaesthesia (OBA) in 400 patients aged 60 years or older undergoing elective surgery expected to last less than 90 minutes. Within 48 hours, the composite of hypoxemia, delirium, or postoperative nausea and vomiting occurred in 25.0% with OFA and 43.5% with OBA (adjusted odds ratio, 0.40; 95% CI, 0.25 to 0.62; p < .001). OFA was also associated with less hypoxemia and nausea and vomiting, but more intraoperative bradycardia and longer extubation times.
Key findings
- The 48-hour composite outcome occurred in 25.0% with OFA versus 43.5% with OBA (adjusted odds ratio, 0.40; 95% CI, 0.25 to 0.62; p < .001).
- Hypoxemia occurred in 15.0% with OFA versus 32.0% with OBA; postoperative nausea and vomiting occurred in 8.0% versus 16.0%.
- Intraoperative bradycardia was more frequent with OFA (10.0% vs 3.0%; p = .005), and mean extubation time was longer (9.5 vs 7.2 min; p < .001).
- Intraoperative hemodynamic stability was greater in the OFA group.
Why it matters
In older adults having short-duration surgery, the trial suggests that an opioid-free anaesthetic approach may reduce common postoperative complications, particularly hypoxemia and nausea and vomiting. The trade-offs are clinically relevant: bradycardia was more frequent and extubation took longer. These findings help frame the balance of postoperative benefits and intraoperative or recovery effects when considering anaesthetic approaches in this population.
What to keep in mind
The trial was conducted at a single centre in China and assessed outcomes only within 48 hours; the findings may not generalize to other settings or longer-duration surgery.