{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T19:01:49Z","timestamp":1789412509320,"version":"build-2803163510"},"reference-count":26,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T00:00:00Z","timestamp":1669075200000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Science and Technology Development Plan Clinical Trial Project","award":["SLT201909"],"award-info":[{"award-number":["SLT201909"]}]},{"name":"Jiangsu Provincial Medical Youth Talents Program","award":["QNRC2016741"],"award-info":[{"award-number":["QNRC2016741"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,11,8]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Opioid-free anaesthesia (OFA) may reduce opioid-related side effects such as postoperative nausea and vomiting (PONV) and hyperalgesia. This study aims to investigate the effects of balanced OFA on PONV and pain outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This randomised controlled trial will be conducted at the First Affiliated Hospital of Soochow University in Suzhou, China. A total of 120 adults scheduled for VATS lung resection will be randomly assigned with a 1:1 ratio to either an OFA group or a control group, stratified by sex (n=60 in each group). Patients will receive balanced anaesthesia with esketamine, dexmedetomidine and sevoflurane (the OFA group), or sufentanil and sevoflurane (the control group). All patients will receive PONV prophylaxis with intraoperative dexamethasone and ondansetron. Multimodal analgesia consists of intraoperative flurbiprofen axetil, ropivacaine infiltration at the end of surgery and postoperative patient-controlled sufentanil. The primary outcome is the incidence of PONV within 48 hours after surgery. Secondary outcomes are nausea, vomiting, need for antiemetic therapy, pain scores at rest and while coughing, postoperative sufentanil consumption, need for rescue analgesia, length of post-anaesthesia care unit stay, length of postoperative hospital stay, and 30-day and 90-day post-surgical pain and mortality. Safety outcomes are hypotension, bradycardia, hypertension, tachycardia, interventions for haemodynamic events, level of sedation, headache, dizziness, nightmare and hallucination. All analyses will be performed in the modified intention-to-treat population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was obtained from the Ethics Committee of the First Affiliated Hospital of Soochow University (2022-042). All patients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry (ChiCTR2200059710).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066202","type":"journal-article","created":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T10:55:59Z","timestamp":1669114559000},"page":"e066202","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of balanced opioid-free anaesthesia on postoperative nausea and vomiting after video-assisted thoracoscopic lung resection: protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"12","author":[{"given":"Yu-qin","family":"Long","sequence":"first","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaomu","family":"Chen","sequence":"additional","affiliation":[{"name":"Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Xu","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Anesthesiology, Suzhou Xiangcheng People\u2019s Hospital, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-dong","family":"Feng","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Hai","family":"Ji","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2879-1759","authenticated-orcid":false,"given":"Ke","family":"Peng","sequence":"additional","affiliation":[{"name":"Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China"},{"name":"Institute of Anaesthesiology, Soochow University, Suzhou, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,11,22]]},"reference":[{"key":"2025121601420345000_12.11.e066202.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00173-X"},{"key":"2025121601420345000_12.11.e066202.2","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-57620-8","article-title":"Moderate-severe postoperative pain in patients undergoing video-assisted thoracoscopic surgery: a retrospective study","volume":"10","author":"Sun","year":"2020","journal-title":"Sci Rep"},{"key":"2025121601420345000_12.11.e066202.3","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200102000-00022"},{"key":"2025121601420345000_12.11.e066202.4","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-011-9660-x"},{"key":"2025121601420345000_12.11.e066202.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032196"},{"key":"2025121601420345000_12.11.e066202.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30430-1"},{"key":"2025121601420345000_12.11.e066202.7","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.bpa.2017.11.002","article-title":"Special indications for opioid free anaesthesia and analgesia, patient and procedure related: including obesity, sleep apnoea, chronic obstructive pulmonary disease, complex regional pain syndromes, opioid addiction and cancer surgery","volume":"31","author":"Sultana","year":"2017","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"2025121601420345000_12.11.e066202.8","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.bpa.2019.09.002","article-title":"Opioid-free anesthesia","volume":"33","author":"Beloeil","year":"2019","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"2025121601420345000_12.11.e066202.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aet551"},{"key":"2025121601420345000_12.11.e066202.10","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.bjan.2014.05.006","article-title":"Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study","volume":"65","author":"Bakan","year":"2015","journal-title":"Braz J Anesthesiol"},{"key":"2025121601420345000_12.11.e066202.11","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinane.2021.110437","article-title":"Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial","volume":"75","author":"Massoth","year":"2021","journal-title":"J Clin Anesth"},{"key":"2025121601420345000_12.11.e066202.12","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1097\/ALN.0000000000003725","article-title":"Balanced Opioid-free anesthesia with dexmedetomidine versus balanced anesthesia with remifentanil for major or intermediate noncardiac surgery","volume":"134","author":"Beloeil","year":"2021","journal-title":"Anesthesiology"},{"key":"2025121601420345000_12.11.e066202.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586"},{"key":"2025121601420345000_12.11.e066202.14","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199909000-00022"},{"key":"2025121601420345000_12.11.e066202.15","article-title":"Intranasal dexmedetomidine in elderly subjects with or without beta blockade: a randomised double-blind single-ascending-dose cohort study","volume":"S0007-0912","author":"Barends","year":"2020","journal-title":"Br J Anaesth"},{"key":"2025121601420345000_12.11.e066202.16","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/den.12678","article-title":"Prospective, randomized, placebo-controlled trial evaluating the efficacy and safety of propofol sedation by anesthesiologists and gastroenterologist-led teams using computer-assisted personalized sedation during upper and lower gastrointestinal endoscopy","volume":"28","author":"Kashiwagi","year":"2016","journal-title":"Dig Endosc"},{"key":"2025121601420345000_12.11.e066202.17","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinane.2020.110007","article-title":"Preoperative duloxetine to improve acute pain and quality of recovery in patients undergoing modified radical mastectomy: a dose-ranging randomized controlled trial","volume":"67","author":"Hetta","year":"2020","journal-title":"J Clin Anesth"},{"key":"2025121601420345000_12.11.e066202.18","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1097\/ALN.0000000000003557","article-title":"Hypotension prediction index for prevention of hypotension during moderate- to high-risk noncardiac surgery","volume":"133","author":"Maheshwari","year":"2020","journal-title":"Anesthesiology"},{"key":"2025121601420345000_12.11.e066202.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0257279","article-title":"Opioid-free anesthesia compared to opioid anesthesia for lung cancer patients undergoing video-assisted thoracoscopic surgery: a randomized controlled study","volume":"16","author":"An","year":"2021","journal-title":"PLoS One"},{"key":"2025121601420345000_12.11.e066202.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c869"},{"key":"2025121601420345000_12.11.e066202.21","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.2147\/DDDT.S316804","article-title":"Effect of intravenous lidocaine on serum interleukin-17 after video-assisted thoracic surgery for non-small-cell lung cancer: a randomized, double-blind, placebo-controlled trial","volume":"15","author":"Hou","year":"2021","journal-title":"Drug Des Devel Ther"},{"key":"2025121601420345000_12.11.e066202.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2009.07.040"},{"key":"2025121601420345000_12.11.e066202.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2006.09.035"},{"key":"2025121601420345000_12.11.e066202.24","first-page":"109","article-title":"Non-intubated anesthesia in thoracic surgery-technical issues","volume":"3","author":"Kiss","year":"2015","journal-title":"Ann Transl Med"},{"key":"2025121601420345000_12.11.e066202.25","first-page":"1960","article-title":"Pain control of thoracoscopic major pulmonary resection: is pre-emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia?","volume":"7","author":"Yang","year":"2015","journal-title":"J Thorac Dis"},{"key":"2025121601420345000_12.11.e066202.26","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.athoracsur.2021.09.014","article-title":"Impact of Opioid-free anesthesia after video-assisted thoracic surgery: a propensity score study","volume":"114","author":"Selim","year":"2022","journal-title":"Ann Thorac Surg"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-066202","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:42:12Z","timestamp":1765878132000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-066202"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,22]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/bmjopen-2022-066202"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-066202","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}