Opioid-free versus opioid-based anesthesia for day surgery laparoscopic inguinal hernia repair under ERAS protocol: a randomized non-inferiority trial.

Chun Wang, Peng Shi, Jun Xu, Xiaohua Fan, Jinjun Bian, Lulong Bo

Abstract readRandomized Controlled TrialComparative StudyEquivalence Trial

In one paragraph

Trial report in Hernia : the journal of hernias and abdominal wall surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Chun Wang *Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.ORCID http://orcid.org/0009-0002-9334-0911

Peng Shi *Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.

Jun Xu *Department of Gastrointestinal Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.

Xiaohua FanDepartment of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.

Jinjun BianDepartment of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.

Lulong BoDepartment of Anesthesiology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China. bartbo@smmu.edu.cn.ORCID http://orcid.org/0000-0001-6787-1837

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeLaparoscopic 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.

methodsThis 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.

resultsThe 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.

conclusionUnder 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 registrationChiCTR2500098054, registered on February 28, 2025, retrospectively registered.

Indexed as

Ambulatory Surgical ProceduresAnalgesics, OpioidEnhanced Recovery After SurgeryHernia, InguinalHerniorrhaphyLaparoscopyPostoperative PainAdultAgedAnesthetics, LocalDexmedetomidineFemaleHumansLidocaineMaleMiddle AgedAnalgesics, OpioidAnesthetics, LocalDexmedetomidineLidocaineRemifentanilSufentanilDay surgeryEnhanced recoveryInguinal herniaMultimodal analgesiaOpioid-free anesthesia

Identifiers

PMID40632161

DOI10.1016/j.bja.2021.04.024

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.