Perbandingan Teknik Anestesi tanpa Opioid dan Anestesi Berbasis Opioid terhadap Indeks qNOX pada Pembedahan Abdomen dengan Anestesi Umum

Abstract

ABSTRACT COMPARISON OF OPIOID-FREE AND OPIOID-BASED ANESTHESIA TECHNIQUES ON qNOX INDEX IN ABDOMINAL SURGERY UNDER GENERAL ANESTHESIA

Muhammad Rahman E. Nasution1, Andriamuri P. Lubis2, Muhammad Arshad2, Putri Eyanoer3 1Resident of Anesthesiology and Intensive Care Program, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia 2Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia 3Department of Community and Preventive Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

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 into 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 independent t-test and 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. However, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in the OFA group (0%) than in the OBA group (47.6%; p<0.001). Conclusion: Opioid-Free Anesthesia provides comparable nociceptive control and hemodynamic stability to Opioid-Based Anesthesia while significantly reducing PONV incidence. OFA represents a safe and effective alternative for abdominal surgery under general anesthesia.

Keywords: opioid-free anesthesia, opioid-based anesthesia, qNOX, abdominal surgery