ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1606383
Efficacy of Opioid-Free Anesthesia in Reducing Postoperative Nausea and Vomiting Following Gynecological Laparoscopic Surgery: A Randomized Controlled Trial
Provisionally accepted
- International Peace Maternity and Child Health Hospital, Shanghai, Shanghai Municipality, China
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Background: Postoperative nausea and vomiting (PONV) are a common complication following gynecological laparoscopic surgery, with opioid use being a significant contributing risk factor. Opioid-free anesthesia (OFA) has emerged as an alternative approach to mitigate opioid-related adverse effects. This study aimed to evaluate the efficacy of OFA in reducing PONV and its impact on postoperative recovery.Methods: This randomized, double-blind, controlled trial enrolled 92 female patients undergoing elective gynecological laparoscopic surgery. The patients were randomized 1:1 into two groups, whereby the OFA group received anesthesia with esketamine (0.3 mg/kg) and dexmedetomidine (0.6 µg/kg), while the control group received conventional opioid-based anesthesia with sufentanil (0.3 µg/kg). Both groups underwent preoperative transversus abdominis plane (TAP) block with ropivacaine (20 mL per side). Standardized perioperative monitoring and analgesic protocols were maintained. The primary outcome was the incidence of PONV within 48 hours postoperatively. Secondary outcomes included the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score recovery time, postoperative pain scores, antiemetic and analgesic use, and quality of recovery (QoR-15 scores).Results: On postoperative day 1, PONV incidence was significantly lower in the OFA group (15.2%) compared to the control group (34.8%) (P = 0.03), and by postoperative day 2, the difference between the groups was no longer statistically significant (P = 0.475). The OFA group exhibited a longer median extubation time (11.0 min vs. 5.5 min, P < 0.001) and a prolonged MOAA/S recovery time (45.0 min vs. 40.0 min, P = 0.012). Pain scores, postoperative sufentanil consumption, and QoR-15 scores did not differ significantly between groups. No patients in either group required postoperative supplemental analgesics, and three patients in each group received antiemetic treatment solely on the first postoperative day.Conclusion: OFA incorporating TAP block may reduce early PONV following gynecological laparoscopic surgery while maintaining adequate pain control and overall recovery quality.
Keywords: Opioid-free anesthesia, Nausea, Vomiting, Esketamine, Dexmedetomidine, Transversus abdominis plane block
Received: 08 Apr 2025; Accepted: 13 Jun 2025.
Copyright: © 2025 Shen, Wu, Tang, Wang, Ma and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianwei Wang, International Peace Maternity and Child Health Hospital, Shanghai, 200000, Shanghai Municipality, China
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