Comparison of quality of recovery with opioid-based versus opioid free anaesthesia in pediatric patients undergoing brain tumor surgeries A Prospective randomized control trial

Group A patients will receive inj. fentanyl 2mcg/kg and Group B patients will receive inj. dexmedetomidine 0.5 mcg/kg/hr over 10 minutes. On successful bag mask ventilation, inj atracurium 0.5mg/kg will be given. The airway will be secured with appropriate size endotracheal tube. Scalp block will be given with 0.5% ropivacaine in group B according to surgical incision site (1ml of 0.5% ropivacaine will be given at each of the 6 nerves i.e. supratrochlear nerve, supraorbital nerve, auriculotemporal nerve, zygomatic temporal nerve, greater and lesser occipital nerve). Anaesthesia will be maintained with sevoflurane + O2 and air (50-50%) in both the groups. In group A, continuous fentanyl infusion (1 µg/kg/hr) and in group B, continuous dexmedetomidine infusion (0.4 mcg/kg/hr) will be started immediately after induction. In Group A, fentanyl infusion and in Group B, dexmedetomidine infusion will be stopped 15 min before the expected completion of surgery. Inj. Paracetamol (10 mg/kg) will be given in both the groups 10 min before the expected completion of surgery. After returning of spontaneous respiration and reversal of residual neuromuscular blockade using neostigmine (0.05 mg/kg) and glycopyrrolate  (0.01mg/kg), patients will be extubated. The duration of anaesthesia and surgery will be noted in both the groups.. The patients will be monitored in post anaesthetic care unit (PACU) and discharged from PACU after achievement of modified Aldrete score. The time of PACU discharge will be noted and compared between the study groups.Quality of recovery will be assessed by Paediatrics QOR 15 score. QOR will be assessed at the baseline and at 24 hrs in both the groups and difference between QOR at the baseline and at 24 hrs will be compared between both the groups. The anaesthetist assessing the QOR 15 score will be different from the anaesthetist involved in the induction of anaesthesia and application of scalp block.Postoperatively, Pain score will be assessed using the numerical 0–10 visual analogue scale (VAS). The pain will be classified as mild pain (score 0–3), moderate (score 4–6) to severe (score 7–10) pain. Assessment of pain by scale will be on arrival to PACU and postoperatively at 30 min, 2 h, 6 h, 12 hand 24 h .In the PACU, the necessity for rescue analgesia will be decided by the pain score. Rescue medication will be administered when patients will have score of ≥4 on at least 2 occasions or will show obvious signs of pain. Intravenous diclofenac ( in a dose of 1.5 mg/kg ) will be used as a rescue analgesic for all the patients. The number of doses of rescue medication required and the time of administration of first dose rescue medication will also be noted. In the postoperative period, patients will also be monitored for adverse effects, including respiratory depression, vomiting. Respiratory depression will be defined as a decrease in oxygen saturation <93%, requiring oxygen by face mask.