Comparison of long-term outcomes between opioid-free and opioid-based anesthesia in head and neck cancer surgeries: A pilot study.

Background, aim, and objective: Literature is replete with studies evaluating opioid-sparing strategies in head and neck cancer (HNC) surgeries; however, no study has attempted opioid-free anesthesia (OFA). Various long-term outcomes have not been evaluated in any cancer surgeries. This study aimed to compare OFA with standard opioid-based anesthe-sia (OBA) in HNC surgeries. The primary objective was the incidence of chronic post-surgical pain (CPSP), and the sec-ondary objective included Numeric Rating Scale (NRS)-Pain scores, Neuropathic Pain Symptom Inventory (NPSI), Douleur Neuropathique 4 (DN-4), Pain Detect Questionnaire (PDQ), and Short Form-12 (SF-12) scores. MATERIALS AND METHOD: Following Instituitional Ethics Committee approval and prospective Clinical Trials Registry-India registration, the study included patients with American Society of Anesthesiologists Physical Status II or III, aged 20-65 years, who were undergoing HNC surgeries. Patients were excluded if they had a history of post-operative nausea, chronic pain, opioid use, local anesthetic allergies, coagulopathies, or cognitive dysfunction. Group OFA received oral pregabalin and dexmedetomidine and ketamine intravenous (IV) infusions perioperatively. Group OBA received standard OBA with IV morphine boluses. The various aforementioned secondary objectives were recorded at the fourth, sixth, eighth, and 12th weeks. RESULT: Fifty patients, with 25 in each group, were included. The demographic profiles were comparable between the groups. NRS-Pain (Rest) was comparable; however, mean NRS (Cough) and NRS (Swallow) scores were lower in the OF group at the sixth week; however, this difference was not significant. No patients developed CPSP in any group. No sig-nificant differences were recorded in PDQ, NPSI, DN-4, Activity Assessment Scale, and SF-12 scores. Similarly, me-chanical ventilation duration, intensive care unit stay, total hospital stays, and mortality rates were comparable. CONCLUSION: We did not observe any association between CPSP and OFA in HNC surgeries. Additionally, pain intensity, neuropathic pain component, quality of recovery, and quality of life were comparable.