Opioid-free versus opioid-based anesthesia for quality of recovery following laparoscopic hysterectomy: a randomized controlled non-inferiority trial.
Yifen Zhuo, Dongsheng Dai, Bin Qian et al.
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In 30 seconds
This randomized non-inferiority trial compared opioid-free with opioid-based anesthesia in 110 women with ASA physical status I–II undergoing elective laparoscopic hysterectomy. At 24 hours, recovery quality was non-inferior with opioid-free anesthesia: median QoR-15 scores were 123 versus 121, with a 2.0-point median difference (95% CI -1.0-4.0, p < 0.001). Postoperative morphine consumption was comparable. Postoperative nausea and vomiting (PONV) was less frequent and less severe in the opioid-free group; no serious adverse events occurred.
Key findings
- Median 24-hour QoR-15 scores were 123 with opioid-free versus 121 with opioid-based anesthesia; the 2.0-point difference met the non-inferiority criterion.
- PONV occurred in 10/55 (18.2%) versus 20/55 (36.4%); relative risk 0.50, 95% CI 0.26-0.97, p = 0.032.
- PONV severity was lower with opioid-free anesthesia (odds ratio 0.39, 95% CI 0.16-0.94, p = 0.035).
- Postoperative morphine consumption was comparable: 8 mg [IQR 8-12] versus 10 mg [IQR 8-12], median difference p = 0.315.
Why it matters
The trial suggests that, in this elective laparoscopic hysterectomy population, avoiding intraoperative opioids can preserve measured early recovery quality while reducing PONV. This is clinically relevant because PONV is a common postoperative complication and may affect recovery. The findings also indicate that opioid-free anesthesia did not increase postoperative morphine consumption in this study.
What to keep in mind
The study included only women with ASA physical status I–II undergoing elective laparoscopic hysterectomy, limiting how directly the findings apply to other populations and procedures.