Prospective Randomized Comparison of Opioid-Based Versus Non-Opioid-Based Anaesthetic Protocols for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)

<b>Background:</b> The evolution of interventional pulmonology has necessitated the refinement of anesthetic techniques to ensure the safety and efficacy of procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), particularly when performed outside the conventional operating room setting. The management of anesthesia in patients with significant comorbidities, classified as American Society of Anesthesiologists (ASA) class III, presents distinct challenges. In this context, the transtracheal block emerges as a viable alternative to total intravenous anesthesia (TIVA) for these high-risk procedures. Objectives: This study aims to evaluate the comparative safety and efficacy of opioid-based intravenous analgesia versus a regimen combining sedative agents with transtracheal block in the administration of anesthesia for EBUS TBNA in high-risk patients. Design: We conducted a randomized observational study involving 57 elective EBUS-TBNA patients classified as ASA class III. <b>Methods:</b> Participants were allocated into two cohorts: one receiving intravenous opioid analgesia and the other receiving a combination of sedative agents with transtracheal block. Collected data encompassed patient demographics, medical history, incidence of adverse events during anesthesia, indicators of sympathetic nervous system activation, patient satisfaction levels, and the procedural conditions as assessed by the operator. <b>Results:</b> Opioid anesthesia was associated with increased desaturation (95.7% vs. 60.6%; <i>p</i> < 0.05) and higher pain-related sympathetic responses (VAS and SCI at 40-100; <i>p</i> < 0.05). No differences in other adverse events, patient satisfaction, or procedural conditions were noted. <b>Conclusions:</b> In summary, the study indicates that transtracheal block combined with sedatives may be a safer anesthetic alternative to opioid-based regimens for high-risk EBUS-TBNA patients, reducing desaturation and pain-related sympathetic activity without affecting satisfaction or procedural efficacy.