Opioid-free anaesthesia cut postoperative oxycodone use in robotic prostatectomy

Design

Single-centre randomised controlled trial

Population

149 men having robot-assisted radical prostatectomy (75 opioid-free, 74 opioid-based)

Primary outcome

Cumulative 24-hour oxycodone patient-controlled analgesia consumption

Effect

Median 12.0 vs 19.0 mg (p = 0.001); Hodges-Lehmann difference -6.0 mg (95% CI -10.0 to -2.0)

This single-centre randomised trial allocated 149 men having robot-assisted radical prostatectomy 1:1 to opioid-free anaesthesia (dexmedetomidine plus ketamine, no intraoperative opioids) or a remifentanil-based technique. Both groups had the same premedication, bilateral quadratus lumborum block, sevoflurane and oxycodone patient-controlled analgesia.

Cumulative 24-hour oxycodone use was lower with the opioid-free technique (median 12.0 mg, IQR 6.0 to 22.0) than with remifentanil (19.0 mg, 10.5 to 34.0; p = 0.001), a Hodges-Lehmann difference of -6.0 mg (95% CI -10.0 to -2.0). Pain scores did not differ at any time, nausea and vomiting were infrequent and similar, and intraoperative haemodynamic events, white cell count and creatinine were similar.

A 6 mg median difference is modest, and it was achieved on top of a regional block. It is a single-centre trial and the abstract does not say who was blinded, so the finding supports a conversation with the anaesthesia team, not a unit-wide change.

• 24-hour oxycodone use was lower with opioid-free anaesthesia (median 12.0 vs 19.0 mg, p = 0.001).
• Pain scores did not differ at any time point.
• Haemodynamic events, nausea and creatinine were similar.
• Both groups had a quadratus lumborum block, so results may not apply without regional analgesia.
• Discuss with your anaesthetic team; single-centre evidence.

Why it matters

Reducing opioids after prostatectomy is a stated goal in enhanced recovery pathways.

Don't overread it

The primary outcome was a drug-use measure, not recovery or long-term pain, and the trial was at a single centre.

The statistics, in plain English

A difference of 6 mg in median oxycodone is statistically clear, but whether it matters to patients depends on side effects and recovery, which were not clearly different. The confidence interval of -10 to -2 mg indicates the true saving could be small.

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