Opioid-free versus opioid-based anesthesia for robot-assisted radical prostatectomy: a single-center randomized controlled trial.
Tomasz Składzień, Aleksandra Żmuda, Michał Cicio et al.
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In 30 seconds
This single-center randomized controlled trial compared opioid-free anesthesia (dexmedetomidine plus ketamine) with remifentanil-based anesthesia in adult men undergoing robot-assisted radical prostatectomy. Both groups received the same multimodal and regional analgesia and postoperative oxycodone patient-controlled analgesia. Among 149 analyzed patients, median oxycodone use during the first 24 postoperative hours was lower with opioid-free anesthesia: 12.0 mg [IQR 6.0-22.0] versus 19.0 mg [10.5-34.0] (p=0.001). Pain scores, postoperative nausea and vomiting, hemodynamic adverse events, and measured laboratory changes did not differ significantly between groups.
Key findings
- Median 24-hour oxycodone consumption was 12.0 mg [IQR 6.0-22.0] with opioid-free anesthesia versus 19.0 mg [10.5-34.0] with remifentanil-based anesthesia (p=0.001).
- Pain scores did not differ between groups at any measured time point.
- Postoperative nausea and vomiting was infrequent, with no significant between-group difference.
- Hemodynamic adverse events, perioperative white-cell count, and serum creatinine did not differ between groups.
Why it matters
The trial provides randomized evidence that eliminating intraoperative opioids can reduce subsequent oxycodone use in robot-assisted prostatectomy when both approaches are delivered alongside the same multimodal and regional analgesia. The absence of a detected difference in pain scores or measured safety outcomes is relevant to evaluating this strategy, while the findings apply to the specific anesthetic and postoperative analgesic protocols studied.
What to keep in mind
The trial was conducted at a single center, and its findings concern a specific multimodal and regional analgesic protocol and the first 24 postoperative hours.