Comparison of postoperative recovery after opioid-free total intravenous anaesthesia with propofol-ketamine vs. propofol-dexmedetomidine: A ramdomised controlled trial

• Author Details:   
• Nishant Kumar
• Sahir Alam ^*
• Maitree Pandey

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Background and Aims: Opioid-free anaesthesia (OFA) is an emerging approach in modern anaesthesiology aimed at reducing opioid consumption and its associated side effects. The combination of total intravenous anaesthesia (TIVA) with agents such as propofol, ketamine, and dexmedetomidine has shown promise in enhancing recovery while minimizing opioid use. This study aimed to compare the postoperative recovery time between two opioid-free total intravenous anaesthesia regimens, propofol-ketamine and propofol-dexmedetomidine, in patients undergoing routine surgical procedures.

Methods: Sixty patients aged between 18-50 yrs, ASA I & II undergoing elective surgery of duration 1-4 hrs were randomly divided in two equal groups: group I propofol-ketamine and group II propofol-dexmedetomidine. Group I received ketamine 1mg/kg over 10 mins followed by 0.5mg/kg/hr. Group II received dexmedetomidine 1µg/kg over 10 mins followed by 0.5µg/kg/hr. Anaesthesia was induced by propofol 200µg/kg/min titrated to maintain BIS 40-60 and endotracheal intubation facilitated by rocuronium 0.6mg/kg. Hemodynamic parameters and BIS were recorded. Recovery time (modified Aldrete score), total propofol consumption, peri-operative complications, PONV, explicit recall, hallucinations and 24 hrs analgesic requirement were noted. Appropriate statistical tests were applied and p<0.05 was considered significant.

Results: Recovery time was longer in group I [21 (CI: 19-22) min] compared to group II [17 (CI: 16-18) min; p< 0.001]. There was no statistical difference in the incidence of tachycardia, hypotension, and hypertension between the two groups. Total propofol consumption and BIS were higher in group 1 (p<0.001). PONV was more in group I (26.7% vs 16.7%). Total 24 hrs analgesic requirement was more in group II but was statistically insignificant.

Conclusion: Although mean BIS, total propofol consumption and time required to achieve modified Aldrete score ≥9 was higher with ketamine as compared to dexmedetomidine, the difference is not significant clinically and either agent can be used depending on the patient condition and anaesthesiologist’s discretion.