OPIOID SPARING & SUPPRESSION OF HEMODYNAMIC RESPONSE BY PREOPERATIVE MULTIMODAL NON-OPIOID ANALGESIC REGIME IN LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA: A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

Background & Aims: Laparoscopic surgeries produces significant hemodynamic changes leading to increased opioid consumption. This study aims to assess the efficacy of a unique opioid free multimodal analgesia in the prevention of adverse hemodynamic changes during intubation and pneumoperitoneum in a patient undergoing laparoscopic surgery in comparison with standard opioid based anaesthesia. Material & Methods: Sixty patients undergoing elective laparoscopic surgery were randomly assigned into two groups Group OFA (Opioid Free Anaesthesia) received tablet pregabalin 150mg 1hour prior to induction. Intravenous ketorolac 30mg, magnesium sulphate 30 mg/kg, preservative free lidocaine 1.5mg/kg, dexamethasone 8mg was administered as an analgesic mixture in 100ml normal saline half an hour prior to induction. Dexmedetomidine 1mcg/kg diluted in 100ml saline was given over 10minutes prior to induction. Group OBA (Opioid Based Anaesthesia) received placebo tablet 1hour prior to induction,100ml normal saline half an hour prior to induction and 100 ml saline was given over 10minutes prior to induction. The primary outcome was to compare the efficacy of hemodynamic suppression to intubation and pneumoperitoneum. Other outcome parameters observed were perioperative analgesia, opioid sparing and adverse effects. Results: Significant suppression of heart rate and blood pressure following intubation and pneumoperitoneum by OFA multimodal regime was seen compared to Opioid based technique (P ＜ 0.05) along with prolonged duration of postoperative analgesia (9.45+/-3.6 vs 4.03+/-1.6 hrs). Conclusion: Our unique non-opioid multimodal regime is a safe and effective method that provides significant suppression of stress responses induced during laparoscopic surgery.