Opioid-free versus opioid-based anaesthesia and analgesia for patients at low risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial
Authors' conclusion
When individualising anaesthesia based on predicted risk for APOP, OFA is non-inferior to a traditional GABAA and opioid-based anaesthesia strategy, for patients with a low risk for APOP undergoing laparoscopic surgery.
Study context
- Population
- Adults, ASA I–II, elective laparoscopic surgery, low risk for acute postoperative pain (VAS < 2.0 on venous cannulation)
- Participants
- 154 adults
- Comparison
- Opioid-free anaesthesia vs standard of care
- Primary endpoint
- Worst pain intensity in the PACU
Methodological detailspatient- and assessor-blinded, non-inferiority, single-centre, March 2022 to February 2024
- Patient- and assessor-blinded
- Non-inferiority
- Single-centre
- March 2022 to February 2024
Primary result
As reported in the abstract
Opioid-free anaesthesia (OFA)
4.8
Standard of care (SOC)
4.6
P = 0.67
Secondary outcomes
- Worst pain at rest (NRS) · 24 h — Worst pain at rest, OFA vs SOC
- 5.7 vs 5.0 · P = 0.11
- Worst pain during movement (NRS) · 24 h — Worst pain during movement, OFA vs SOC
- 5.6 vs 5.3 · P = 0.43
- Proportion with NRS ≥ 4 in the PACU — NRS ≥ 4 in the PACU, OFA vs SOC
- 66 % vs 69 % · P = 0.65
- Proportion with NRS ≥ 4 at rest · 24 h — NRS ≥ 4 at rest at 24 h, OFA vs SOC
- 76 % vs 60 % · P = 0.042
- Proportion with NRS ≥ 4 during movement · 24 h — NRS ≥ 4 during movement at 24 h, OFA vs SOC
- 73 % vs 69 % · P = 0.65
- Postoperative recovery · 24 h — Postoperative recovery, OFA vs SOC · no significant difference
- 99 vs 102 · P = 0.44
- Rescue opioids in the PACU (exploratory) — Rescue opioids in the PACU, OFA vs SOC · OFA group required less rescue opioids · exploratory outcome
- 3.4 mg vs 5.1 mg · P = 0.039
Persistent postoperative pain (PPOP) · 3 and 6 months
- No significant difference in PPOP at 3 or 6 months, at rest (P = 0.51, P = 0.56) or movement (P = 0.72, P = 0.48)
Safety
| Outcome | P value |
|---|---|
| PONV · PACU and 24 hOFA vs SOC · PACU | P = 0.93 |
| PONV · PACU and 24 hOFA vs SOC | P = 0.52 |
PONV · PACU and 24 h
- No significant difference
Original publication
Opioid-free versus opioid-based anaesthesia and analgesia for patients at low risk for acute postoperative pain undergoing laparoscopic surgery: A randomised controlled trial. J Clin Anesth. Published 31 October 2025. doi:10.
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