Opioid-Free Anesthesia For Robot-Assisted Hysterectomy In Severe Obesity

BACKGROUND: Patients with morbid obesity undergoing general anesthesia for laparoscopic surgery have an increased risk of complications: transient hypoxemia, hemodynamic instability, delayed emergence, increased sensitivity to opioids, postoperative pulmonary complications, and postoperative nausea and vomiting. Optimizing anesthetic management without the use of opioids is a relevant task.

CLINICAL CASE DESCRIPTION: The patient is 35 years old, height — 164 cm, weight — 180 kg (body mass index — 66.9 kg/m²). A robot-assisted hysterectomy was performed due to recurrent endometrial hyperplasia using combined anesthesia (general anesthesia combined with epidural analgesia).

 The mean qCON (quantium consciousness index) during the operation was 50.2. The analgesic component of anesthesia was achieved through epidural administration of 0.1% ropivacaine hydrochloride solution — 10 mL every 30 minutes, with a bolus infusion rate of 250 mL/h. The mean qNOX (quantium nociception index) was 29.8. The average total peak qNOX duration was 98.2 seconds over 2 hours and 35 minutes of surgery. Intraoperative hemodynamics were stable — BP 120/70-140/80 mmHg, HR 70-80 bpm, SpO₂ 98-100%. Additional administration of rocuronium bromide for muscle relaxation was not required due to adequate relaxation of the abdominal wall and the absence of spontaneous inspiration triggering by the patient. The neuromuscular conduction index by TOF ranged from 40 to 50%, while the electromyography (EMG) value ranged from 10 to 25, indicating adequate relaxation of the anterior abdominal wall muscles. The postoperative period proceeded without complications. The patient was discharged on the sixth day after the surgery in satisfactory condition without active complaints.

CONCLUSION: In this clinical case, the chosen anesthetic strategy allowed for effective analgesia and facilitated early activation of the patient.