To evaluate the impact of electroencephalogram-guided opioid-free anesthesia (OFA) on perioperative blood glucose variability in patients undergoing video-assisted thoracic surgery. This article is a secondary analysis of a randomized controlled trial. Eligible patients were randomly allocated to either the OFA group or the opioid-based anesthesia (OBA) group. Patients in the OFA group did not receive any opioids during surgery, whereas those in the OBA group received sufentanil and remifentanil intraoperatively. The primary end point was the coefficient of variation for glucose (GLUcv), calculated based on predefined time points during the perioperative period. The secondary end points were the mean of glucose (GLUmean), the standard deviation of glucose (GLUSD), mean amplitude of glycemic excursions (MAGE), and largest amplitude of glycemic excursion (LAGE). A total of 126 patients were included in the final analysis: the OFA group (n = 64) and the OBA group (n = 62). Blood pressure, heart rate, sedation index, and analgesia index during surgery were comparable between the two groups, and there was no significant difference in pain in the early postoperative period. The primary end point, GLUCV, was significantly higher in OFA group than in OBA group (22.7 ± 9.1 vs 14.1 ± 6.0, P < 0.001). In addition, the OFA group had higher GLUmean (5.68 ± 0.87 vs 5.31 ± 0.87 mmol/L, P = 0.003), GLUSD (1.3 ± 0.59 vs 0.76 ± 0.40 mmol/L, P < 0.001), MAGE (1.75 ± 0.86 vs 0.95 ± 0.54 mmol/L, P < 0.001), and LAGE (2.97 ± 1.35 vs 1.72 ± 0.96 mmol/L, P < 0.001). The OFA regimen provides sedation and analgesia comparable to OBA in video-assisted thoracic surgery, but is associated with greater perioperative blood glucose variation. Clinicaltrials.gov, Identifier: NCT05411159. First posted date: 9 Jun, 2022. Date of enrolment of the first research participant: 10 Jun, 2022.
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