Comparison of Opioid-Free and Opioid-Based Anesthesia Techniques on qNOX Index in Abdominal Surgery under General Anesthesia
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Abstract
Background: Opioid-Free Anesthesia (OFA) is a multimodal approach designed to avoid intraoperative opioid use, aiming to reduce side effects such as respiratory depression, nausea, vomiting, and postoperative dependency. This study aimed to compare the effectiveness of OFA and Opioid-Based Anesthesia (OBA) on the qNOX index during abdominal surgery under general anesthesia.
Methods: This randomized double-blind controlled trial involved 42 adult patients undergoing elective abdominal surgery under general anesthesia in three hospitals in Medan. Subjects were assigned to two groups: OFA (ketamine, lidocaine, and dexmedetomidine combination) and OBA (fentanyl-based). The qNOX index was measured using the CONOX® monitor at five time points: before induction, during intubation, before incision, during incision, and one hour after incision. Data were analyzed using an independent t-test and a chi-square test.
Results: No significant difference in qNOX values was observed between groups at any time point (p>0.05). Both groups maintained comparable intraoperative hemodynamic stability.
Conclusion: Opioid-free anesthesia provides comparable nociceptive control and hemodynamic stability to opioid-based anesthesia. OFA represents a safe and effective alternative for abdominal surgery under general anesthesia.
[2] Zhang J, Wang J, Han X, Fan J, Huang C, Dong Y, et al. Global burden and future trends of inguinal, femoral, and abdominal hernia in older adults: A systematic analysis from the Global Burden of Disease Study 2021. PLoS One. 2025; 20(6):e0323790.
[3] Jadoon SK, Khan RM, Khan TA, Akhtar N, Qayyum Y, Kumar K, et al. Comparative study of wound infection between elective and emergency abdominal surgeries: A retrospective cohort study. Ann Med Surg (Lond). 2023; 85(5):1490-5.
[4] Zhao L, Sun Z, Shen W, Zeng Y. Clinical application of dexmedetomidine combined with dezocine in local anesthesia for endoscopic dacryocystorhinostomy. Ear Nose Throat J. 2025; 104(4):NP210-5.
[5] Accurso G, Rampulla D, Cusenza M, Candela G, Savatteri P, Vetrugno L, et al. A blended opioid-free anesthesia protocol and regional parietal blocks in laparoscopic abdominal surgery-a randomized controlled trial. Sci Rep. 2025; 15(1):14097.
[6] da Silveira CA, Rasador AC, Medeiros HJ, Slawka E, Gesteira L, Pereira LC, et al. Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis. Can J Anaesth. 2024; 71(11):1466-85.
[7] Kang J, Fang C, Li Y, Yuan Y, Niu K, Zheng Y, et al. Effects of qCON and qNOX-guided general anaesthesia management on patient opioid use and prognosis: a study protocol. BMJ Open. 2023; 13(5):e069134.
[8] Masharto AR, Lubis AP, Bangun CG, Wahyuni AS. Quantium Consciousness Index and Quantium Noxious Index in Ketamine Subdose Administration Compared with Fentanyl and Midazolam in Postoperative ICU Patients: A Prospective, Observational Study. Indian J Crit Care Med. 2024; 28(6):581-6.
[9] K R V, Singh K, Sahay N, Sinha C, Kumar A, Kumar N. Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. Anesth Pain Med (Seoul). 2024; 19(2):109-16.
[10] Linassi F, Vide S, Ferreira A, Schneider G, Gambús P, Kreuzer M. Relationships between the qNOX, qCON, burst suppression ratio, and muscle activity index of the CONOX monitor during total intravenous anesthesia: a pilot study. J Clin Monit Comput. 2024; 38(6):1281-90.
[11] Kong H, Ma DD, Ma JH, Zhang YX, Zhang H, Wang DX, et al. Qnox index for quantification of intraoperative nociception and analgesia: a prospective single-centre validation study. Br J Anaesth. 2025; 134(3):736-45.
[12] Walujo AM, Dewi DAMS, Pradhana FXAP. Opioid-Free Anesthesia (OFA) as a Safe Anesthetic Choice for Epilepsy Patient. Bioscientia Med. 2023; 7(12):3846-50.
[13] Sakan S, Turudić Ž, Peremin S, Šribar A, Sojčić N, Čučković M, et al. OPIOID FREE GENERAL ANESTHESIA IN CLINICAL PRACTICE - A REVIEW ARTICLE. Acta Clin Croat. 2023; 62(2):362-7.
[14] Nair VA, Gladston DV, Krishna KM J, Koshy RC. Effects of intravenous dexmedetomidine on perioperative haemodynamics and quality of emergence in patients undergoing head and neck surgery following general anaesthesia—a comparative randomized, double-blind placebo-controlled study. Ain-Shams J Anesthesiol. 2022; 14(1):28.
[15] Puentes Garcia JA, Tocancipa DR, Medina E, Díaz JJ, Pisso, Gil VJ, et al. Effectiveness and Safety of Opioid-Free Anaesthesia and Analgesia in pain control and postoperative recovery of patients undergoing gynaecologic oncologic surgery: a retrospective cohort study. BMC Anesthesiol. 2025; 25(1):75.
[16] Tripodi VF, Sardo S, Ippolito M, Cortegiani A. Effectiveness and safety of opioid-free anesthesia compared to opioid-based anesthesia: a systematic review and network meta-analysis. J Anesth Analg Crit Care. 2025; 5(1):53.
[17] Liebe T, Li S, Lord A, Colic L, Krause AL, Batra A, et al. Factors Influencing the Cardiovascular Response to Subanesthetic Ketamine: A Randomized, Placebo-Controlled Trial. Int J Neuropsychopharmacol. 2017; 20(11):909-18.
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| Keywords | ||
| Opioid-free anesthesia Opioid-based anesthesia qNOX index Abdominal surgery | ||
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