Opioid-Free Anesthesia with Epidural Analgesia in A Patient with Opioid Intolerance: A Case Report

Abstract

Background: Opioid-Free Anesthesia (OFA) is an alternative anesthetic technique performed without the use of opioids or their derivatives. This approach has been associated with reduced postoperative nausea and vomiting, better hemodynamic stability, and faster recovery. Although widely studied, the application of OFA in patients with multiple drug allergies, particularly opioid hypersensitivity, is still rarely reported. Moreover, its implications extend to perioperative pain management in various surgical fields, including maxillofacial surgery where patients may present with similar anesthetic challenges.

Case Report: We describe a 14-year-old male patient weighing 37 kg, with a history of allergies to multiple drugs including paracetamol, NSAIDs, antihistamines, ondansetron, and fentanyl, who presented with acute abdominal pain and bowel obstruction requiring emergency bowel surgery. General anesthesia was induced with ketamine, midazolam, rocuronium, and lidocaine, followed by thoracic epidural catheter placement with continuous ropivacaine infusion. Intraoperative management and postoperative course were uneventful, with effective pain control (Numeric Rating Scale 0–3/10), hemodynamic stability, early bowel function recovery, and no complications related to the epidural catheter. The patient required no opioids or additional analgesics throughout perioperative care.

Conclusion: This case highlights the feasibility and safety of using opioid-free anesthesia with thoracic epidural analgesia in patients with multiple drug hypersensitivities undergoing emergency bowel surgery. Beyond gastrointestinal surgery, OFA may also be considered a valuable alternative in perioperative pain management for maxillofacial and other surgical patients with contraindications to opioids.