Comparison of Recurrence of Malignancy Following Two Opioid-free General Anesthesia Regimens versus Standard Care Using Opioids: A Retrospective Analysis.
Sunil Rajan, Gayathri Sreekumar, Roniya Ann Roy, Lokeshshiva Arul, Mahesh Madhu, Jerry Paul
Annals of African Medicine June 11, 2025 DOI: 10.4103/aam.aam_119_25 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective cohort study Peer reviewed |
|---|---|
| Sample size | 150 |
| Population | Patients with advanced head-and-neck malignancies undergoing excision with reconstruction surgery |
| Interventions | Lidocaine Dexmedetomidine Ketamine Morphine |
| Dose | Lidocaine 1.5 mg/kg bolus followed by 1 mg/kg/h infusion; Dexmedetomidine 1 mcg/kg bolus with ketamine 0.5 mg/kg followed by dexmedetomidine 0.5 mcg/kg/h with ketamine 0.5 mg/kg/h infusion; Morphine 0.2 mg/kg bolus followed by 2 mg/h infusion |
| Duration | 1-year follow-up |
| Topics | Ketamine |
| Keywords | Anesthésie sans opioïdes Dexmedetomidine Dexmédétomidine Kétamine Lignocaine Malignité Opioid-free anesthesia Cancer treatment Lidocaine lidocaïne Cancer recurrence malignancy Anesthetic |
| Key findings | Opioid-free anesthesia using lidocaine was associated with a significantly lower incidence of cancer recurrence within one year compared to dexmedetomidine-ketamine or morphine-based regimens. |
Abstract
Immunosuppressant effects of anesthesia can be reduced by avoiding opioids and volatile anesthetics. We retrospectively compared incidence of recurrence of malignancy in patients with advanced head-and-neck malignancies who had undergone excision with reconstruction surgery 1 year back and had received two different regimens of opioid free anesthesia (OFA) versus standard regimen using morphine. Durations of surgery, intensive care unit (ICU), and hospital stay and mortality at 1 year were also compared. Retrospective analysis conducted in 150 patents comprising of three equal groups. Group L had received intravenous lidocaine bolus 1.5 mg/kg followed by infusion 1 mg/kg/h. Group D received intravenous dexmedetomidine 1 mcg/kg bolus with ketamine 0.5 mg/kg followed by dexmedetomidine 0.5 mcg/kg/h with ketamine 0.5 mg/kg/h infusion. Group M received morphine 0.2 mg/kg bolus followed by an infusion 2 mg/h. The disease process at 1 year following surgery was assessed by reviewing medical records and contacting the patient or relative telephonically. Mean durations of surgery and ICU stays were comparable in all three groups. Duration of hospital stay was significantly lower in Group L. Patients in all groups had comparable regular postoperative follow-up visits. Incidence of recurrence of malignancy within 1 year of surgery was significantly lower in Group L. Mortality was comparable in all three groups. Patients with advanced carcinoma of tongue and buccal mucosa who received OFA using lidocaine during surgery demonstrated a significantly lower recurrence rate of malignancy at 1 year postoperatively compared to those who received OFA regimen utilizing dexmedetomidine with ketamine and traditional anesthesia with opioids.
Comparable studies
Other observational and cohort studies on ketamine, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Taming the Ketamine Tiger Volunteers from a prison population | 2010 | Observational study | n = 20 |
| Increased spontaneous MEG signal diversity for psychoactive doses of ketamine, LSD and psilocybin Humans | 2017 | Observational study | |
| Disruption of Frontal–Parietal Communication by Ketamine, Propofol, and Sevoflurane Surgical patients undergoing induction of anesthesia with intravenous ketamine | 2013 | Observational cohort | n = 30 |
| Do the dissociative side effects of ketamine mediate its antidepressant effects? Treatment-resistant inpatients with major depressive disorder or bipolar disorder | 2014 | Observational cohort | n = 108 |
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |