Opioid-free versus opioid-based anesthesia for day surgery laparoscopic inguinal hernia repair under ERAS protocol: a randomized non-inferiority trial
- 01.12.2025
- Original Article
Erschienen in:
- Verfasst von
- Chun Wang
- Peng Shi
- Jun Xu
- Xiaohua Fan
- Jinjun Bian
- Lulong Bo
- Erschienen in
- Hernia | Ausgabe 1/2025
Abstract
Purpose
Laparoscopic inguinal hernia repair (LIHR) is increasingly performed as a day surgery procedure under enhanced recovery after surgery (ERAS) protocol. While opioid-based anesthesia (OA) remains standard, its adverse effects may impair postoperative recovery. This randomized controlled non-inferiority trial assessed whether opioid-free anesthesia (OFA) provides non-inferior postoperative pain control to OA for day surgery LIHR under ERAS protocol and evaluated comprehensive recovery outcomes.
Methods
This single-center, prospective, randomized non-inferiority trial enrolled 90 patients scheduled for day surgery LIHR who were randomly allocated to receive either lidocaine-dexmedetomidine-based OFA (n = 45) or sufentanil-remifentanil-based OA (n = 45). The primary outcome was postoperative 24-h time-weighted average visual analog scale (TWA-VAS) pain score at rest. Secondary outcomes included extended pain assessment, quality of recovery indicators, day surgery pathway efficiency, and perioperative hemodynamic stability.
Results
The 24-h TWA-VAS scores were 1.84 ± 1.02 in the OFA group and 1.77 ± 0.88 in the OA group (mean difference: 0.07; 95% CI: -0.33–0.47), establishing non-inferiority. The OFA group experienced significantly lower rates of intraoperative hypotension (8.9% vs. 53.3%; relative risk: 0.17; P = 0.001) but longer laryngeal mask airway removal time (20 vs. 15 min; P = 0.034) and post-anesthesia care unit stay (50 vs. 45 min; P = 0.018). No significant differences were observed in Quality of Recovery-15 scores, rescue analgesia requirements, postoperative urinary retention (POUR), postoperative nausea and vomiting (PONV), or 24-h discharge success rates.
Conclusion
Under ERAS protocol, lidocaine-dexmedetomidine-based OFA provided non-inferior analgesic efficacy to OA for day surgery LIHR, while delivering superior hemodynamic stability. Despite modestly prolonged emergence times, OFA maintained comparable recovery quality and discharge success rates. These findings establish OFA as a valuable alternative anesthetic strategy for day surgery LIHR under ERAS protocol, particularly for patients at risk of opioid-related adverse effects.
Trial registration
ChiCTR2500098054, registered on February 28, 2025, retrospectively registered.
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- Titel
- Opioid-free versus opioid-based anesthesia for day surgery laparoscopic inguinal hernia repair under ERAS protocol: a randomized non-inferiority trial
- Verfasst von
-
Chun Wang
Peng Shi
Jun Xu
Xiaohua Fan
Jinjun Bian
Lulong Bo
- Publikationsdatum
- 01.12.2025
- Verlag
- Springer Paris
- Erschienen in
-
Hernia / Ausgabe 1/2025
Print ISSN: 1265-4906
Elektronische ISSN: 1248-9204 - DOI
- https://doi.org/10.1007/s10029-025-03410-y
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