Comparison Between Opioid Free Anesthesia and Opioid Based Anesthesia in Laparoscopic Hysterectomy: A Systematic Review
DOI:
https://doi.org/10.24843/JATI.2025.v01.i02.p03Keywords:
Hysterectomy, opioid-free anesthesia, general anesthesia, opioid based anesthesia, pain scoreAbstract
Introduction: In Gynecology field, laparoscopy surgery is used for many procedures that were traditionally performed via laparotomy. Hysterectomy associated with postoperative pain, which greatly affected postoperative recovery and patient satisfaction. Combinations of opiod base analgesia (OBA) and opioid free analgesia (OFA) agents are combined with local or regional anesthesic techniques whenever possible.
Methods: A systematic search of relevant databases was conducted to identify case control studies comparing OBA and OFA post hysterectomy procedure. Inclusion criteria encompassed studies reporting Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) as an outcome measure. Quality assessment and data extraction were performed independently by author.
Results: The systematic review identified a total of four case-control studies meeting the inclusion criteria with total of 357 patients undergone hysterectomy procedure. The sample sizes varied across the studies, with the smallest study including 30 patients and the largest study including 157 patients. The outcomes were assessed using VAS and NRS scores. The results consistently showed that either OBA or OFA administration giving similar outcome on pain scale.
Conclusion: All studies concluded whether OBA or OFA administration peri or postoperative given similar or not significantly different of pain scoring outcomes. Although OFA would give a better result to maintain post operative nausea and vomitting (PONV) and reducing opiod-related adverse events that happen postoperatively.
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1. Johnson N, Barlow D, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. Epub ahead of print 2005. DOI: 10.1002/14651858.cd003677.pub2.
2. Medeiros LR, Stein AT, Fachel J, et al. Laparoscopy versus laparotomy for benign ovarian tumor: A systematic review and meta-analysis. Int J Gynecol Cancer 2008; 18: 387–399.
3. Cohen SL, Ajao MO, Clark N V., et al. Outpatient Hysterectomy Volume in the United States. Obstet Gynecol 2017; 130: 130–137.
4. Thigpen JT. Recurrence and Survival After Random Assignment to Laparoscopy Versus Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group LAP2 Study. Yearb Oncol 2012; 2012: 130–131.
5. Bollag L, Lim G, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean. Anesth Analg 2021; 132: 1362–1377.
6. Feenstra ML, Jansen S, Eshuis WJ, et al. Opioid-free anesthesia: A systematic review and meta-analysis. J Clin Anesth 2023; 90: 111215.
7. Massoth C, Schwellenbach J, Saadat-Gilani K, et al. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial. J Clin Anesth 2021; 75: 22–28.
8. Hakim KK, Wahba WB. Opioid-free total intravenous anesthesia improves postoperative quality of recovery after ambulatory gynecologic laparoscopy. Anesth Essays Res 2019; 13: 199.
9. Choi JW, Joo JD, Kim DW, et al. Comparison of an intraoperative infusion of dexmedetomidine, fentanyl, and remifentanil on perioperative hemodynamics, sedation quality, and postoperative pain control. J Korean Med Sci 2016; 31: 1485–1490.
10. Gazi M, Abitağaoğlu S, Turan G, et al. Evaluation of the effects of dexmedetomidine and remifentanil on pain with the analgesia nociception index in the perioperative period in hysteroscopies under general anesthesia: A randomized prospective study. Saudi Med J 2018; 39: 1017–1022.
11. Wu CL, King AB, Geiger TM, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naïve Patients. Anesth Analg 2019; 129: 567–577.
12. Burns ML, Hilliard P, Vandervest J, et al. Variation in Intraoperative Opioid Administration by Patient, Clinician, and Hospital Contribution. JAMA Netw Open 2024; 7: E2351689.
13. Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: Theory and practice. Anesth Analg 2018; 127: 1246–1258.
14. Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, et al. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia 2019; 74: 651–662.
15. King CA, Perez-Alvarez IM, Bartholomew AJ, et al. Opioid-free anesthesia for patients undergoing mastectomy: A matched comparison. Breast J 2020; 26: 1742–1747.
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Copyright (c) 2025 Ode Mahesa Putra, I Ngurah Arya Wicaksana (Author)
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