{"id":"doi:10.1080/07853890.2026.2732292","kind":"article","title":"Opioid-free analgesia with esketamine-dexmedetomidine versus opioid-based analgesia after gynaecological laparoscopic surgery: a double-blind, randomized, controlled trial","authors":["Ren Y","Li YT","Yin QL","Li HP","Zhang PJ","Cao JH","Yu B","Yang XL","Yang ZZ","Kong H"],"author_count":10,"year":2026,"published":"2026-09-16","venue":"Annals of medicine","cited_by":0,"doi":"10.1080/07853890.2026.2732292","arxiv_id":null,"nct_id":null,"source_url":"https://doi.org/10.1080/07853890.2026.2732292","archive_url":"https://space-kitty.com/papers/doi:10.1080/07853890.2026.2732292","updated":null,"pmid":"42745658","pmcid":"PMC13587535","openalex_id":null,"pdf_url":"https://europepmc.org/articles/PMC13587535/pdf","abstract":"Background Postoperative opioid-based analgesia after gynecological laparoscopic surgery often causes dizziness, nausea and vomiting, with limited benefit for mood and sleep. We tested whether opioid-free analgesia combining dexmedetomidine and esketamine was non-inferior to sufentanil-based opioid analgesia for pain control and superior for postoperative recovery quality. Methods Adult ASA I-III patients undergoing elective gynecological laparoscopic surgery were randomized 1:1. The opioid-free group received patient-controlled intravenous analgesia (PCIA) with esketamine 1 mg kg -1 plus dexmedetomidine 3 μg kg -1 ; the opioid group received sufentanil 2 μg kg -1 . The primary non-inferiority endpoint was the area under the curve (AUC) of numerical rating scale (NRS) pain scores during coughing within 48 h postoperatively; the primary superiority endpoint was the mean quality of recovery (QoR)-15 score on postoperative days 1 and 2. Results Of 134 randomized patients, 132 were analyzed per intention-to-treat. Pain control was non-inferior in the opioid-free group (AUC 175 [47] vs 169 [37]; mean difference 6, 95%CI -8 to 20; non-inferiority margin 24, p = 0.008). The mean QoR-15 score was significantly higher in the opioid-free group (116 [10] vs 108 [12]; mean difference 8, 95%CI 4-12; p < 0.001), driven by better physical comfort and emotional state domain scores, with comparable pain domain scores. No serious adverse events occurred. Conclusions Postoperative opioid-free analgesia with dexmedetomidine and esketamine provides analgesia non-inferior to sufentanil-based opioid analgesia and significantly improves postoperative quality of recovery, and may serve as a promising alternative strategy for postoperative analgesia in this population.Trial registration: This trial was registered at the Chinese Clinical Trial Registry (identifier: ChiCTR2300078569) on 12 December 2023 before patient recruitment.","abstract_license":"CC-BY (article license as recorded by Europe PMC; abstract reproduced unmodified apart from markup removal)","license":"CC-BY","is_open_access":true,"retracted":false,"peer_reviewed":null,"categories":[],"details":null,"provenance":"europepmc","attribution":"Abstract of \"Opioid-free analgesia with esketamine-dexmedetomidine versus opioid-based analgesia after gynaecological laparoscopic surgery: a double-blind, randomized, controlled trial\" by Ren Y, Li YT, Yin QL et al., https://doi.org/10.1080/07853890.2026.2732292, used under its Creative Commons Attribution license (CC-BY); markup removed, otherwise unmodified.","topics":[{"slug":"psychiatric-therapeutics","name":"Novel Psychiatric Therapeutics","domain_slug":"neuroscience"}],"cited_in_dossiers":[]}