Esketamine/dexmedetomidine–based opioid-free anesthesia and its association with postoperative bowel and cognitive dysfunction after total laparoscopic hysterectomy

作者：Guohua Li, Yingbing Lv, Song Gao, Xinyu Yao, Shaohui Ren, Liyuan Dong, Xiao Li · 发表于：BMC Anesthesiology · 年份：2025 · DOI：10.1186/s12871-025-03301-w · 被引用次数：3 · 研究领域：Anesthesia and Pain Management、Cardiac, Anesthesia and Surgical Outcomes、Anesthesia and Sedative Agents

BACKGROUND: Opioid-free anesthesia (OFA) protocols using esketamine and dexmedetomidine have shown potential benefits for perioperative pain control with fewer side effects. We explored whether an esketamine–dexmedetomidine OFA regimen accelerates bowel recovery and preserves cognitive function after laparoscopic total hysterectomy. METHODS: In this prospective observational cohort study, we enrolled 114 women undergoing elective total laparoscopic hysterectomy (TLH). Anesthesia technique—esketamine–dexmedetomidine–based OFA (OFA group) versus standard opioid-based anesthesia (OBA group)—was chosen by the attending anesthesiologist. Key perioperative variables, including drug dosages and rescue analgesics, were recorded. The primary outcome was the time to first bowel movement. Secondary endpoints included incidence of postoperative ileus, pain scores, opioid consumption, and postoperative cognitive function assessed by the Montreal Cognitive Assessment (MoCA) at baseline and postoperative Days 1 and 3. RESULTS: Among the 114 participants (OFA group n = 59; OBA group n = 55), median time to first bowel movement was significantly shorter in the OFA group (42 h [IQR 38–48]) compared with the OBA group (49 h [IQR 42–56]; p < 0.01). Postoperative ileus occurred in 6% of OFA patients versus 15% of OBA patients (p = 0.07). Postoperative MoCA scores showed a smaller decline from baseline in the OFA group (mean difference − 1.2 ± 1.0) compared with the OBA group (− 2.3 ± 1.5; p < 0.0...