OPOID FREE ANESTHETIC MIXTURE VERSUS TRAMADOL FOR PREEMPTIVE ANALGESIA: A COMPARATIVE STUDY

Abstract

Background:

Postoperative pain management is a critical component of perioperative care, particularly in abdominal surgeries. Opioid-free anesthesia (OFA) has been proposed as an alternative to traditional opioid-based analgesia to minimize opioid-related side effects while maintaining effective pain control. This study aims to compare the postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol, lignocaine, and magnesium sulfate versus standard opioid anesthesia using intravenous tramadol for preemptive analgesia in patients undergoing elective abdominal surgeries under general anesthesia.

Aim : To compare the postoperative analgesic efficacy of opioid-free anesthesia using intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) versus standard opioid anesthesia using intravenous tramadol (2 mg/kg) for preemptive analgesia in patients undergoing elective abdominal surgeries under general anesthesia. The study evaluates pain scores, rescue analgesia requirements, hemodynamic stability, and opioid-related side effects between the two groups.

Methods : A prospective comparative study was conducted on patients undergoing elective abdominal surgeries under general anesthesia. Patients were randomly assigned into two groups:

- Group OFA (Opioid-Free Anesthesia): Received intravenous paracetamol (15 mg/kg), lignocaine (2 mg/kg), and magnesium sulfate (20 mg/kg) in 100 mL normal saline (NS) as preemptive analgesia in the preanesthetic room.

- Group OA (Opioid Anesthesia): Received intravenous tramadol (2 mg/kg) in 100 mL NS as preemptive analgesia in the preanesthetic room.

All patients underwent a preanesthetic checkup one day prior and on the day of surgery as per hospital protocol. Standard ASA fasting guidelines were followed. After completion of the preemptive analgesia infusion, patients were shifted to the operation theater. Standard monitoring was applied, and general anesthesia was induced with intravenous midazolam (0.03 mg/kg), glycopyrrolate (0.2 mg), propofol (2 mg/kg), and atracurium (0.5 mg/kg) to facilitate endotracheal intubation. Anesthesia was maintained with a mixture of oxygen and air with sevoflurane. 

Results: Postoperative pain scores (VAS at 1, 3, 6, 12, and 24 hours) were significantly lower in the OFA group compared to the OA group. The need for rescue analgesia was reduced in the OFA group. Hemodynamic stability was better maintained in the OFA group, and opioid-related side effects such as nausea, vomiting, and sedation were significantly lower. 

Conclusion: Opioid-free anesthesia using intravenous paracetamol, lignocaine, and magnesium sulfate provides effective postoperative analgesia with reduced opioid-related adverse effects compared to conventional opioid-based anesthesia using intravenous tramadol. The findings suggest that OFA may be a viable alternative for postoperative pain management in abdominal surgeries.