Opioid-Free Total Intravenous Anaesthesia Improves Postoperative Quality of Recovery After Ambulatory Gynecologic Laparoscopy: A Retrospective Comparative Study.
DOI:
https://doi.org/10.51168/9aczze49Keywords:
opioid-free anaesthesia, total intravenous anaesthesia, ambulatory surgery, gynecologic laparoscopy, postoperative recovery, QoR-15Abstract
Background:
To compare postoperative quality of recovery and perioperative outcomes between opioid-free total intravenous anaesthesia (OFTIVA) and conventional opioid-based total intravenous anaesthesia (OTIVA) in women undergoing ambulatory gynecologic laparoscopy.
Materials and Methods:
This retrospective comparative study included 120 women who underwent elective ambulatory gynecologic laparoscopy under total intravenous anaesthesia at Gouri Devi Institute of Medical Sciences and Hospital, West Bengal, India, from March 2025 to April 2026. Patients were categorized into OFTIVA (n=60) and OTIVA (n=60) groups according to the anaesthetic technique documented in hospital records. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 hours. Secondary outcomes included postoperative pain, postoperative nausea and vomiting (PONV), rescue analgesic requirement, time to ambulation, post-anaesthesia care unit (PACU) stay, haemodynamic variables, and patient satisfaction.
Results:
The OFTIVA group had significantly higher QoR-15 scores than the OTIVA group (130.6 ± 7.8 vs 119.4 ± 9.3; p<0.001). VAS pain scores were significantly lower with OFTIVA at 2, 6, 12, and 24 hours (all p<0.001). PONV occurred in 10.0% versus 31.7% of patients (p=0.003), while rescue analgesia was required in 26.7% versus 65.0% (p<0.001). OFTIVA was associated with earlier ambulation (5.9 ± 1.5 vs 7.8 ± 2.0 hours; p<0.001) and shorter PACU stay (76.5 ± 15.3 vs 98.7 ± 19.6 minutes; p<0.001). Patient satisfaction was also significantly higher with OFTIVA (p=0.002). Mean heart rate was lower with OFTIVA (73.8 ± 7.5 vs 79.4 ± 8.6 beats/min; p<0.001), while hypotension and bradycardia did not differ significantly.
Conclusion:
OFTIVA was associated with improved postoperative recovery and comparable haemodynamic outcomes compared with OTIVA in women undergoing ambulatory gynecologic laparoscopy.
Recommendation:
OFTIVA may be considered for appropriately selected patients undergoing gynecologic laparoscopy. Prospective multicentre studies are recommended to confirm these findings.
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