Patients undergoing nephrectomy have a high incidence of postoperative pain. In the perioperative period, these patients are often treated with patient-controlled opioids, epidural analgesia, or both. While effective, both of these treatment modalities carry risk, ie, opioids have a side effect profile including pruritus, nausea,vomiting, increase the risk of oversedation and apnea in patients at risk (eg, those with sleep apnea), difficulty in voiding, and ileus. These complications may lead to a prolonged hospital stay. High dose opioids can also cause acute opioid tolerance and hyperalgesia. Epidurals have been associated with hypotension, post dural puncture headaches, changes in management of anticoagulation Opioid free anesthesia (OFA) is a technique in which no intraoperative opioid administered through any route, including systemic, neuraxial, or tissue infiltration.Opioid free anesthesia has many advantages especially avoiding opioid overdose and opioid-induced hyperalgesia. The most important advantage of OFA seems to be the potential improvement of recovery profile in obese patients. OFA depends on combinations of non-opioid agents and adjuncts, including propofol, lidocaine, magnesium, dexmedetomidine, and ketamine to produce anesthesia, and analgesia. Aim of the work our study aim to compare the analgesic effect of OFA and opioid based general anesthesia using pre emptive wound infiltration in patients undergoing open radical nephrectomy surgery. Objectives: 1. To evaluate analgesic effect of each group intra operative {heart rate, and systolic and diastolic blood pressure } 2. To evaluate analgesic effect of each group post operative \[total opioid consumption in 24h postoperative , Postoperative VAS , hemodynamic). 3. To estimate the incidence of early postoperative complication in both groups
Age range
18 Years – 70 Years
Sex
ALL
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The Time to first request of opioid analgesia
Timeframe: it will be measured from tracheal extubation to first request of postoperative analgesia in the first 24 hours postoperative and it will be expressed in minutes