Opioid-Free Anesthesia in Laparoscopic Cholecystectomy

Abstract

Introduction: Opioid-free anesthesia (OFA) using multimodal non-opioid drugs (lidocaine, ketamine, dexmedetomidine) aims to reduce postoperative opioid side effects. This review evaluates OFA feasibility in laparoscopic cholecystectomy.
Methods: Literature review (2018–2024) of RCTs comparing OFA to opioid-based anesthesia (OBA) in adults undergoing elective laparoscopic cholecystectomy. Primary outcomes: postoperative pain scores (VAS at 2h) and rescue analgesia. Secondary: PONV.
Results: Nine RCTs (n=852) showed no significant difference in pain scores (VAS 2h: OFA 2.5 vs. OBA 2.3, p=0.41) or rescue analgesia need (28% vs. 25%, p=0.57). OFA reduced PONV (12% vs. 24%, p=0.01) but had higher intraoperative bradycardia (8% vs. 2%, p=0.03).
Discussion: OFA is non-inferior for analgesia in laparoscopic cholecystectomy but reduces PONV. Hemodynamic instability from dexmedetomidine/lidocaine requires vigilance. Lack of long-term outcome data.
Conclusions: Opioid-free anesthesia is a safe alternative for selected patients undergoing laparoscopic cholecystectomy, especially those at high PONV risk. Not superior in pain control.