Opioid Free Anesthesia Versus Opioid Based Anesthesia in Patients Undergoing Laparoscopic Hysterectomy: A Prospective Randomized Double Blind Controlled Study

Background: laparoscopic hysterectomy (LH) is a widely performed minimally invasive gynecological surgery. These procedures typically cause a moderate to less severe level of pain. This study aimed to compare OpioidFree Anesthesia (OFA) with OpioidBased Anesthesia (OBA) in patients undergoing laparoscopic hysterectomy. Methods: This double blinded randomized controlled study was conducted on sixty female patients who underwent elective laparoscopic hysterectomy under general anaesthesia (GA) and were randomized into two equal groups, OFA group included 30 patients received Dexmedetomidine and S-ketamine with IV infusion whereas OBA group included 30 patients received IV infusion of fentanyl. The primary outcome was the visual analogue scale (VAS) for pain in the post anesthesia care unit (PACU). The secondary outcomes were VAS score at 2, 6, 12, 24, and 48 hours, post operative total ketorolac consumption, mean arterial pressure (MAP), Heart rate (HR), peripheral oxygen saturation (SpO2), time to recovery and postoperative complications. Results: VAS Scores in the PACU were lower in the OFA group but didn’t reach statistical significance (P=0.091). However, pain scores were significantly lower in the OFA group than OBA at 2, 6, 12, 24, and 48 hours postoperatively (P=0.001). Postoperative total ketorolac consumption within the first 24 hours was significantly reduced in the OFA group. The incidence of postoperative nausea and vomiting (PONV) and shivering was also significantly lower in the OFA group, while intraoperative hemodynamic stability was maintained in both groups. Conclusion: OFA provided stable intraoperative hemodynamics, lower postoperative analgesic requirements, and fewer opioid related complications. Although the primary outcome which was PACU VAS score difference wasn’t statistically significant, OFA achieved a sustained and clinically relevant analgesic benefits throughout the postoperative period in laparoscopic hysterectomy.