Balanced Opioid-Free Anesthesia on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial Protocol.

Background: Opioids are widely used for anesthesia and postoperative analgesia; however, their use is related to increased risks of untoward effects including hyperalgesia and chronic postsurgical pain (CPSP). We aim to compare opioid-free anesthesia (OFA) with opioid-based anesthesia (OBA) on the incidence of CPSP after video-assisted thoracoscopic surgery (VATS). Methods: This randomized controlled clinical trial was approved by the Medical Ethics Committee of the First Affiliated Hospital of Soochow University, Suzhou, China. A total of 180 adult patients undergoing VATS lung resection will be randomized to receive one of two balanced anesthesia regimens: OFA (dexmedetomidine, esketamine, and sevoflurane) or OBA (sufentanil and sevoflurane). A standardized multimodal analgesia comprises erector spinae plane block, intravenous flurbiprofen axetil, and patient-controlled sufentanil analgesia. The primary outcome is the incidence of CPSP at 3 months after surgery. Secondary outcomes include acute postoperative pain at rest and while coughing (at discharge from post-anesthesia care unit and 6, 24 and 48 hours after surgery), the incidences of postoperative pain at 1 month and 6 months, postoperative 24- and 48-hour sufentanil consumption, adverse events (postoperative nausea and vomiting, headache, dizziness, hallucination, and nightmare), length of post-anesthesia care unit and hospital stay, and the 15-item quality of recovery scores at 48 hours after surgery. Discussion: We hypothesize that the OFA strategy would decrease the incidence of CPSP, reduce postoperative adverse events, and enhance quality of recovery following VATS procedures. Registration: Chinese Clinical Trial Registry (ChiCTR2400081099).