{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T20:42:59Z","timestamp":1786653779751,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>In opioid-free anesthesia (OFA) protocol, intravenous lignocaine can offer perioperative analgesic benefits. However, maintaining adequate anesthetic depth during OFA, particularly with neuromuscular blockade, poses a challenge due to the unreliable nature of hemodynamic parameters as indicators of anesthetic depth. We aimed to compare the end-tidal sevoflurane concentration needed to maintain bispectral index (BIS) values of 40\u201360 in patients undergoing major head-and-neck cancer surgery using lignocaine-based OFA versus a morphine-based regimen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective, randomized, double-blind study enrolled 30 patients undergoing wide excision and reconstruction for head-and-neck cancer. Group L received a lignocaine bolus (1.5 mg\/kg) and infusion (1 mg\/kg\/h), while Group B received a morphine bolus (0.2 mg\/kg) and 2 mg\/h infusion. Propofol was used to induce anesthesia, and nasal intubation was carried out. Sevoflurane in a 1:1 air-oxygen mixture was used for maintenance, titrated to maintain BIS values between 40 and 60. Additional analgesics were added if indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      End-tidal sevoflurane concentration and sevoflurane consumption were significantly higher in Group L. Hypertension was significantly more frequent in Group L and required significantly more additional analgesics (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Mean heart rate was higher in Group L immediately after induction and at 1 min postintubation, while it was lower at 60 min postintubation. Neither group reported any incidence of intraoperative awareness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Lignocaine-based OFA required a significantly higher end-tidal sevoflurane to maintain sufficient anesthetic depth compared to morphine-based anesthesia. In addition, sevoflurane use, intraoperative hypertension, and the need for supplemental analgesics were notably greater in the OFA group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aam.aam_167_25","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T15:05:41Z","timestamp":1754319941000},"page":"608-613","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of End-tidal Sevoflurane Concentration Required for Optimal Depth of Anesthesia during Opioid-free General Anesthesia Using Intravenous Lignocaine versus Morphine"],"prefix":"10.4103","volume":"25","author":[{"given":"Sunil","family":"Rajan","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Sreekumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roniya Ann","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazil","family":"Haleel","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maneesh Sheela","family":"Manikandan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical 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