Perioperative analgesic efficacy of intravenous infusion of preservative-free xylocaine with ketamine or dexmedetomidine as a total opioid-free anesthesia technique

Objectives: In consequence of the global opioid misuse catastrophe, non-opioid analgesic-based anesthesia has been achieving popularity, as it can obtain the goals of amnesia, hypnosis, and stability of hemodynamics while avoiding opioid adverse effects. The objectives are to study intraoperative as well as postoperative analgesic efficacy, hemodynamic changes, side effects, and complications of the infusion of preservative-free xylocaine, with the infusion of ketamine or dexmedetomidine. Material and Methods: In this randomized study, a total of 60 patients were enrolled, 30 in each group belonging to the American Society of Anaesthesiologists 1 and II, who were aged 18–70 years, both genders and patients undergoing non-cavitary surgeries requiring general anesthesia. Group I received intravenous infusion of xylocaine and ketamine, whereas group II had xylocaine and dexmedetomidine infusion as described below. Initial data were recorded using Stata version 14 software, and various statistical tests (Student’s t -test, Chi-squared test for quantitative variables) were performed. Results: Although no opioids were administered, intraoperatively, the patients in both groups remained absolutely stable hemodynamically, with no variations in any of the parameters. Ramsay sedation score ( P = 0.031) was significantly higher at 8 th h in group II. The analgesia produced by dexmedetomidine was far superior to that produced by ketamine ( P -values ranging from 0.021 to 0.0005). There were no significant perioperative complications in both groups. Conclusion: Both the group drugs can provide as excellent adjuncts for multimodal analgesic regimen to diminish postoperative opioid consumption. Hence, both groups of drugs can be used as a total opioid-free anesthesia/opioid sparing technique. Dexmedetomidine was found to be better than ketamine in terms of post-operative analgesia.