Opioid-Free versus Opioid-Based Anesthesia for Quality of Recovery After Knee Arthroscopy: A Randomized Non-Inferiority Trial.
5 affiliations
- 1Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
- 2Graduate School, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
- 3Department of Anesthesiology, Wenzhou Central Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
- 4Department of Pain, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
- 5Oujiang Laboratory, Zhejiang Laboratory for Regenerative Medicine, Vision and Brain Health, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
Abstract
We determined whether dexmedetomidine- and esketamine-based opioid-free anesthesia (OFA) was non-inferior to opioid-based anesthesia (OA) for 24-hour Quality of Recovery-15 (QoR-15) after elective knee arthroscopy with femoral nerve block. In this patient- and assessor-blinded randomized trial, 70 adults undergoing knee arthroscopy with femoral nerve block were allocated to OFA or OA. The primary outcome was 24-hour QoR-15 (non-inferiority margin, -6 points). Secondary outcomes included pain, rescue analgesia, and adverse events. The primary modified intention-to-treat (mITT) analysis included 66 randomized participants with an assessable 24-hour QoR-15 score (33 per group). Mean 24-hour QoR-15 scores were 126.7 ± 6.4 with OFA and 125.3 ± 6.1 with OA (mean difference 1.45, 95% confidence interval [CI] -1.60 to 4.51), establishing non-inferiority but not superiority. OFA increased rescue opioid requirements (Hodges-Lehmann estimate 10 mg oral morphine equivalents, 95% CI 0 to 10; p=0.037), shortened time to rescue analgesia (hazard ratio 2.11, 95% CI 1.14 to 3.92; p=0.018), and increased early pain. OFA reduced postoperative nausea and vomiting (21.2% vs 48.5%; relative risk 0.44, 95% CI 0.21 to 0.92; p=0.038). Two postoperative bradycardia events occurred with OFA. In adults undergoing elective knee arthroscopy with femoral nerve block, dexmedetomidine- and esketamine-based OFA was non-inferior to OA for 24-hour QoR-15. OFA was associated with lower postoperative nausea and vomiting, but higher early pain and an earlier need for rescue analgesia. Chinese Clinical Trial Registry, ChiCTR2400084207; registered 13 May 2024, before enrollment. URL: https://www.chictr.org.cn/showproj.html?proj=230255.
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BibTeX
@article{huang2026opioidfree,
title = {{Opioid-Free versus Opioid-Based Anesthesia for Quality of Recovery After Knee Arthroscopy: A Randomized Non-Inferiority Trial.}},
author = {Lvdan Huang and Yu Lan and Wangao Li and Xiaona Zhu and Wujun Geng and Kejian Shi},
journal = {Drug design, development and therapy},
year = {2026},
month = oct,
doi = {10.2147/dddt.s644051},
url = {https://europepmc.org/article/MED/42953556},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Opioid-Free versus Opioid-Based Anesthesia for Quality of Recovery After Knee Arthroscopy: A Randomized Non-Inferiority Trial.
AU - Lvdan Huang
AU - Yu Lan
AU - Wangao Li
AU - Xiaona Zhu
AU - Wujun Geng
AU - Kejian Shi
PY - 2026
DA - 2026/10/23
JO - Drug design, development and therapy
DO - 10.2147/dddt.s644051
UR - https://europepmc.org/article/MED/42953556
AB - We determined whether dexmedetomidine- and esketamine-based opioid-free anesthesia (OFA) was non-inferior to opioid-based anesthesia (OA) for 24-hour Quality of Recovery-15 (QoR-15) after elective knee arthroscopy with femoral nerve block. In this patient- and assessor-blinded randomized trial, 70 adults undergoing knee arthroscopy with femoral nerve block were allocated to OFA or OA. The primary outcome was 24-hour QoR-15 (non-inferiority margin, -6 points). Secondary outcomes included pain, rescue analgesia, and adverse events. The primary modified intention-to-treat (mITT) analysis included 66 randomized participants with an assessable 24-hour QoR-15 score (33 per group). Mean 24-hour QoR-15 scores were 126.7 ± 6.4 with OFA and 125.3 ± 6.1 with OA (mean difference 1.45, 95% confidence interval [CI] -1.60 to 4.51), establishing non-inferiority but not superiority. OFA increased rescue opioid requirements (Hodges-Lehmann estimate 10 mg oral morphine equivalents, 95% CI 0 to 10; p=0.037), shortened time to rescue analgesia (hazard ratio 2.11, 95% CI 1.14 to 3.92; p=0.018), and increased early pain. OFA reduced postoperative nausea and vomiting (21.2% vs 48.5%; relative risk 0.44, 95% CI 0.21 to 0.92; p=0.038). Two postoperative bradycardia events occurred with OFA. In adults undergoing elective knee arthroscopy with femoral nerve block, dexmedetomidine- and esketamine-based OFA was non-inferior to OA for 24-hour QoR-15. OFA was associated with lower postoperative nausea and vomiting, but higher early pain and an earlier need for rescue analgesia. Chinese Clinical Trial Registry, ChiCTR2400084207; registered 13 May 2024, before enrollment. URL: https://www.chictr.org.cn/showproj.html?proj=230255.
SN - 1177-8881
ER -