Trial reportAnnals of African medicine2026
Comparison of End-tidal Sevoflurane Concentration Required for Optimal Depth of Anesthesia during Opioid-free General Anesthesia Using Intravenous Lignocaine versus Morphine.
Trial report in Annals of African medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsIn opioid-free anesthesia (OFA) protocol, intravenous lignocaine can offer perioperative analgesic benefits. However, maintaining adequate anesthetic depth during OFA, particularly with neuromuscular blockade, poses a challenge due to the unreliable nature of hemodynamic parameters as indicators of anesthetic depth. We aimed to compare the end-tidal sevoflurane concentration needed to maintain bispectral index (BIS) values of 40-60 in patients undergoing major head-and-neck cancer surgery using lignocaine-based OFA versus a morphine-based regimen.
methodsThis prospective, randomized, double-blind study enrolled 30 patients undergoing wide excision and reconstruction for head-and-neck cancer. Group L received a lignocaine bolus (1.5 mg/kg) and infusion (1 mg/kg/h), while Group B received a morphine bolus (0.2 mg/kg) and 2 mg/h infusion. Propofol was used to induce anesthesia, and nasal intubation was carried out. Sevoflurane in a 1:1 air-oxygen mixture was used for maintenance, titrated to maintain BIS values between 40 and 60. Additional analgesics were added if indicated.
resultsEnd-tidal sevoflurane concentration and sevoflurane consumption were significantly higher in Group L. Hypertension was significantly more frequent in Group L and required significantly more additional analgesics ( P < 0.001). Mean heart rate was higher in Group L immediately after induction and at 1 min postintubation, while it was lower at 60 min postintubation. Neither group reported any incidence of intraoperative awareness.
conclusionLignocaine-based OFA required a significantly higher end-tidal sevoflurane to maintain sufficient anesthetic depth compared to morphine-based anesthesia. In addition, sevoflurane use, intraoperative hypertension, and the need for supplemental analgesics were notably greater in the OFA group.
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