A blended opioid-free anesthesia protocol and regional parietal blocks in laparoscopic abdominal surgery- a randomized controlled trial

In the past 10 years, anesthesiologists have been concentrating on opioid-free anesthesia (OFA) and utilizing locoregional anesthesia/analgesia to manage pain during open and laparoscopic surgeries. The goal is to reduce the negative effects of using opioids during and after surgery. This study aims to evaluate the efficacy and safety of OFA protocol with low doses of magnesium sulfate, Clonidine, and nonsteroidal anti-inflammatory drugs (NSAIDs) employing transversus abdominis plane (TAP) block and rectus sheath block (RSB) for intraoperative and postoperative pain control in laparoscopic abdominal surgery. We conducted a single-center unblinded randomized controlled trial (RCT) to compare the OFA protocol with bilateral TAP and RS block versus the conventional analgesic plan with opioids. We included all consecutive patients older than 18 who planned for laparoscopic scheduled abdominal surgery and underwent general anesthesia. We found a statistically significant lower numeric rating scale (NRS)score at each time point in the OFA group (p < 0.001). A significant statistical difference was also found in the mobilization recovery time, which occurred at 36.00 [18.00, 48.00] hours in the OFA group versus 48.00 [24.00, 72.00] hours in the control one (p < 0.001). The length of stay (LOS) was also in favor of the OFA group 4.00 [2.00, 6.00] days versus 6.00 [4.00, 9.00] days in the control one (p < 0.001). Concerning side effects, there was a reduced/null onset in the OFA group compared with the control. No ICU admissions were recorded in the first 24 h after the end of surgery. This study showed that the preoperative implementation of locoregional anesthesia techniques with our OFA protocols guarantees the adequacy of intraoperative antinociception, while low dose magnesium sulfate and clonidine ensure hemodynamic stability comparable to opioids during surgery. OFA eliminates the side effects of opioids and decreases patients’ length of stay and early mobilization without requiring additional drugs. Trial registration ISRCTN15228105. Retrospectively registered 02/12/2023.