An Evaluation of the Effect of Opioid-Free Anesthesia on Early Quality of Recovery in Patients Undergoing Gynecological Cancer Surgeries: A Randomized Controlled Trial.

Background and objective While quality of recovery (QoR) has been studied in breast cancer surgeries using opioid-free anesthesia (OFA), it has not been assessed as a primary outcome in gynecological cancer surgeries. This study aimed to evaluate QoR using the QoR-40 score in gynecological cancer surgeries, comparing OFA with opioid-based anesthesia (OBA). Secondary outcomes included pain scores, requirement for rescue analgesia, postoperative nausea and vomiting (PONV), hemodynamic parameters, time to first ambulation, DN-4 scores, and length of hospital stay. Methods After obtaining Institutional Ethics Committee (IEC) approval and registration with the Clinical Trials Registry-India (CTRI), the study enrolled American Society of Anesthesiologists Physical Status (ASA-PS) I-II patients aged 20-65 years undergoing exploratory laparotomy for gynecological cancer. Exclusion criteria included chronic pain, a history of PONV, allergy to local anesthetics, coagulopathy, opioid use, or cognitive dysfunction. Group OF received dexmedetomidine and ketamine infusions, whereas group OB received IV morphine. All patients underwent epidural catheter placement and general anesthesia according to the study protocol, with epidural analgesia continued for 48 hours. The aforementioned secondary outcomes were recorded at 12 hours and on postoperative days one, two, and three. Results Eighty patients were enrolled in the study, with 40 patients in each group and comparable demographics. QoR was significantly better with OFA than with OBA. PONV was significantly lower in the OFA group for up to eight hours postoperatively. No significant differences were found in Numerical Rating Scale (NRS)-Pain scores, rescue analgesic use, time to ambulation, oral fluid tolerance, or hospital stay. Conclusions OFA significantly improved postoperative QoR and analgesia, and reduced PONV in patients undergoing gynecological cancer surgery, while intraoperative and postoperative hemodynamics, ambulation, oral fluid tolerance, and hospital stay remained comparable between groups.