Opioid Free Anesthesia versus Opioid Based Anesthesia for Hemodynamic Stability in Geriatric Patients Undergoing Arthroscopic Shoulder Surgery, A Randomized Comparative Study

Background
Physiological and pharmacological variances from younger patients make geriatric patients anesthetically challenging. Opioids though effectively controlling pain may cause serious complications in elderly. Non-opioid analgesics are being considered for adequate analgesia with fewer complications.
Methods
Reaching OR, MAP and HR were recorded (T0), thirty patients were assigned into: OFA group received dexmedetomidine 1 µg/kg over 10 min loading dose, then infusing dexmedetomidine (0.3 µg/kg/h), lidocaine (2 mg/kg/h) and magnesium sulfate (1.5 g/h) during surgery and OA group received fentanyl 2 µg/kg loading dose then infusion (1 µg/kg/h) during surgery. MAP and HR were documented after starting infusions (T1), after intubation (T2), visualizing surgical field with arthroscope (T3) then every 10 min till end. Surgeon graded surgical field (T3) then every 10 min till end. Postoperatively OAA/S, MAP and HR were recorded. NRS was assessed in PACU, at 1 h, 2 h, 8 h, 16 h and 24 h. Patients scoring ≥ 4 received paracetamol 1 gm IV infusion (4 g/24 h maximum dose) documenting first 24 hours total dose and postoperative complications. AMT was assessed postoperatively for three days. Patients scoring<8 were presumed having postoperative cognitive dysfunction (POCD) and were psychiatrically assessed.
Results
MAP and endoscopic surgical field grading (T3) were significantly lower in OFA group than OA group ( values 0.008 and 0.001). MAP was significantly lower in OFA group intraoperative (T3 till T9) and two postoperative hours. HR was significantly lower in OFA group at T3 till surgery end and two postoperative hours (except T13). NRS scores were significantly higher in OA group at P0 and P1 than OFA group (P-value 0.001 and 0.007). Postoperative paracetamol dose was significantly higher in OA group than OFA group (P-value 0.005).
Conclusion
OFA offered better hemodynamic control, endoscopic surgical field grading, lower NRS readings and paracetamol dose, presenting better anesthetic option for elderly undergoing arthroscopic shoulder surgery with no POCD or other postoperative complications.