Balanced Opioid-free Anesthesia with Dexmedetomidine<i>versus</i>Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery

Background It is speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption. However, there currently no evidence to support the speculation. The authors hypothesized balanced anesthetic with dexmedetomidine reduces opioid-related adverse events compared remifentanil. Methods Patients were randomized receive a standard either intraoperative remifentanil plus morphine (remifentanil group) or (opioid-free group). All patients received propofol, desflurane, dexamethasone, lidocaine infusion, ketamine neuromuscular blockade, and paracetamol, nefopam, patient-controlled morphine. primary outcome was composite of (hypoxemia, ileus, cognitive dysfunction) within first 48 h after extubation. main secondary outcomes episodes pain, consumption, nausea vomiting. Results study stopped prematurely because five cases severe bradycardia in group. occurred 122 156 (78%) group 105 (67%) (relative risk, 1.16; 95% CI, 1.01 1.33; P = 0.031). Hypoxemia 110 152 (72%) 94 155 (61%) 1.19; 1.02 1.40; 0.030). There differences ileus dysfunction. Cumulative 0 consumption (11 mg [5 21] versus 6 [0 17]) vomiting (58 157 [37%] 37 [24%]; relative 0.64; 0.45 0.90) both less group, whereas measures analgesia similar groups. Dexmedetomidine had more delayed extubation prolonged postanesthesia care unit stay. Conclusions This trial refuted hypothesis dexmedetomidine, remifentanil, would result fewer events. Conversely, it did greater incidence serious events, especially hypoxemia bradycardia. Editor’s Perspective What We Already Know about Topic Article Tells Us That Is New