Opioid-free anesthesia with quadratus lumborum block and Esketamine enhances postoperative recovery in laparoscopic colon cancer surgery: A randomized controlled trial

To reduce the adverse reactions associated with perioperative opioid use and to enhance postoperative recovery, there has been increasing attention on opioid-free anesthesia(OFA) in recent years. However, the efficacy of OFA in improving recovery outcomes following colon cancer surgery remains uncertain. This study aimed to investigate the effect of OFA on the quality of recovery within 30 days after laparoscopic colon cancer surgery. 140 patients undergoing elective laparoscopic radical surgery for colon cancer were randomly assigned to either an opioid-based anesthesia (A) or OFA (B) group at a 1:1 ratio. Group A received sufentanil and propofol for anesthesia induction, maintained with remifentanil and propofol. Group B had a quadratus lumborum block (QLB) before anesthesia, using esketamine, propofol, and lidocaine for induction and maintenance. The primary outcome measure was the Quality of Recovery-15 (QoR-15) scale, evaluated at 1 day after surgery. Secondary outcomes included the QoR-15 score evaluated at 3, 7, and 30 days postoperatively, pain Numerical Rating Scale (NRS) scores during movement and rest, effective postoperative Patient Controlled Intravenous Analgesia (PCIA) compression, rescue analgesia requests within 48 h, hospital and Post-Anesthesia Care Unit (PACU) stay duration, anesthesia recovery time, and time to first bowel movement. The QoR-15 scores of patients in Group B were significantly higher than those in Group A on postoperative days 1 (A: 100.60 ± 4.38 vs. B: 109.16 ± 4.78, P < 0.001), 3 (A: 110.75 ± 4.22 vs. B: 118.34 ± 5.75, P < 0.001), and 7 (A: 121.94 ± 4.35 vs. B: 126.40 ± 5.71, P < 0.001). Group B had lower NRS scores at rest and during movement at 2, 6, 12, and 24 h post-surgery compared with Group A (P < 0.001). Group B had longer anesthesia recovery (P < 0.001) and PACU stays (P < 0.001) than group A, but fewer PCIA compressions (P < 0.001) and rescue analgesics within 48 h (P < 0.05), shorter times to first flatus (P < 0.05), and shorter postoperative hospital stay (P < 0.05). OFA enhances short-term QoR-15 scores, alleviates pain, and reduces postoperative nausea and vomiting (PONV) after laparoscopic colon cancer surgery. However, it extends anesthesia recovery and PACU stay, with unclear effects on long-term recovery.