# Anesthetics as an Alternative to Opioids in Laparoscopic Surgeries: An Observational Study

## TL;DR

This study explores using anesthetics instead of opioids for pain management in laparoscopic surgeries, showing stable patient outcomes and fewer side effects.

## Contribution

The study introduces opioid-free multimodal analgesia with epidural and general anesthesia as a viable alternative in laparoscopic surgeries.

## Key findings

- Patients experienced stable hemodynamics and acceptable pain scores without opioids.
- Postoperative nausea and vomiting occurred in 18% of patients but was effectively managed.
- Cognitive function remained largely unchanged before and after surgery.

## Abstract

Background: Laparoscopic surgery, though minimally invasive, often results in significant postoperative pain, particularly in the initial hours. While opioids remain a conventional analgesic choice, their use is associated with adverse effects, including respiratory depression, sedation, nausea, and dependency. This study aimed to evaluate the efficacy of opioid-free multimodal analgesia using epidural with general anesthesia to minimize opioid requirements and related complications.

Methods: This observational study was conducted on 50 patients aged >20 years, with American Society of Anesthesiologists (ASA) grade I, II, and III, posted for surgeries under general anesthesia at C.U. Shah Medical College and Hospital, Surendranagar from January 2021 to June 2022 to evaluate opioid free anesthesia in major laparoscopic surgeries on perioperative hemodynamics and postoperative analgesia. The patients were given general anesthesia with epidural anesthesia.

Results: The study population comprised 42 (84%) female and eight (16%) male patients. Hemodynamic monitoring showed stable parameters with no significant variations in heart rate after non-depolarizing muscle relaxant administration, at one hour, two hours, and four hours postoperatively. Similarly, systolic blood pressure, diastolic blood pressure, and mean arterial pressure remained stable at all measured time points.

Pain assessment using the visual analog scale revealed mild discomfort at extubation (mean score: 2.76 ± 0.64), which progressively decreased over the subsequent 24 hours. Sedation level, measured by the Ramsay Sedation Scale, was at its peak at extubation (3.72 ± 0.48) and gradually declined to near-baseline levels by four hours post extubation (1.96 ± 1.13).

Cognitive function evaluation using the Montreal Cognitive Assessment showed no significant difference between preoperative (27.9 ± 1.37) and 24-hour postoperative (26.72 ± 1.37) scores. The incidence of postoperative nausea and vomiting was 18%, successfully managed with 0.15 mg/kg ondansetron, with no other complications reported.

Conclusion: Opioid-free anesthesia combining epidural ropivacaine with general anesthesia provides effective analgesia in laparoscopic surgeries, as evidenced by stable hemodynamics, acceptable pain scores, minimal sedation, high patient satisfaction, and no significant cognitive impairment. This approach may serve as a viable alternative to opioid-based analgesia, reducing associated side effects.