Design: Single-centre randomised controlled trial
Population: 149 men having robot-assisted radical prostatectomy
Primary outcome: Cumulative 24-hour oxycodone use via patient-controlled analgesia
Effect: Median 12 mg vs 19 mg; difference −6.0 mg (95% CI −10.0 to −2.0)

A single-centre randomised trial allocated 149 men having robot-assisted radical prostatectomy to opioid-free anaesthesia with dexmedetomidine and ketamine, or a remifentanil-based technique. Both groups received the same premedication, bilateral quadratus lumborum block, sevoflurane and oxycodone patient-controlled analgesia.

Median oxycodone use in the first 24 hours was 12 mg with opioid-free anaesthesia and 19 mg with remifentanil (difference −6 mg, 95% CI −10 to −2). Pain scores, nausea and vomiting, bradycardia, hypotension and creatinine did not differ.

The reduction is modest and pain was the same, so the clinical gain is small. The reassuring part is that opioid-free anaesthesia was not associated with more haemodynamic instability.

Consider opioid-free anaesthesia for robotic prostatectomy where the team is experienced with dexmedetomidine and ketamine.
Keep a regional block and multimodal analgesia as the foundation, as in both arms of this trial.
Expect a modest opioid saving rather than better pain control.
Monitor for bradycardia and hypotension with dexmedetomidine, though rates did not differ here.

Why it matters

It gives randomised evidence that removing intraoperative opioids is safe in this operation.

The statistics, in plain English

A median difference of 6 mg of oxycodone, with an interval of 2 to 10 mg, is statistically clear but small. Identical pain scores suggest patients did not feel the difference.