Perioperative Analgesic Efficacy of Intravenous Infusion of Lidocaine with Ketamine Vs Dexmedetomedine as Opioid Free Anaesthesia (OFA): A Randomised Controlled Trial

Opioids have been key components of general anesthesia practice from several decades, attributing to their analgesic, hypnotic effects and ability to provide hemodynamic stability intraoperatively. However opioids are associated with several well recognised side effects such as nausea, vomiting, sedation, ileus, urinary retention, pruritus, confusion, delirium, respiratory depression, increased morphine consumption, immunosuppression, hyperalgesia, chronic postoperative pain, addiction and misuse/abuse. This opioid crisis has questioned our general practice of perioperative use of opioids. Techniques are being developed to avoid these adverse effects. Opioid free anesthesia/ analgesia (OFA) or as is also called, opioid sparing technique (OSS), is an effort or ideology or technique where no intraoperative systemic, neuraxial or intracavitary opioid is administered with anesthesia. It is based on the concept of providing multimodal anesthesia/analgesia (MMA) techniques in order to avoid use of perioperative opioids. With this background in our mind, we decided to test this strategy using intravenous infusions of lidocaine in physiological doses to avoid systemic toxicity with either of the two,  potent and well accepted agents viz; ketamine versus dexmedetomidine.