Background and aims Traditionally, opioids have been used regularly during major abdominal surgeries. However, patients may be at risk of ileus, especially if they are used in larger amounts. In addition, they can also develop post-operative nausea and vomiting. Dexemedetomidine infusion is a useful adjunct during anaesthesia as it has good analgesic and anxiolytic properties.

Methods We describe a case of opioid free anaesthesia for an elective laparoscopic right nephroureterotomy which was subsequently converted to open surgery.

Our patient is a 71-year-old male with known hypertension and right urothelial carcinoma. On day of surgery, he presented with rhinorrhea and improving productive cough. Dexmedetomine loading at 1 ug/kg was started over 10 minutes, followed by co-induction with propofol, lignocaine and atracurium. Anaesthesia was maintained with sevoflurane and dexmedetomidine infusion. Dexmedetomidine infusion was titrated between 0.2–0.3 mcg/kg/hr during the laparoscopic phase. After the surgeon decided to convert to open surgery, dexmedetomidine was increased to 0.5mcg/kg/hr. Multimodal analgesia: IV Paracetamol 1 gram, Magnesium 10mmol, Dexamethasone 4 mg, IV Lignocaine infusion.

Results Postoperatively, patient was given a dose of oral oxycodone 5 mg in the recovery. Immediately post-operatively, he was pain free. Patient took regular paracetamol in the ward and no further oxycodone was given. He ambulated on post-op day (POD) 1 and was discharged on POD 4.

Conclusions Opioid free anaesthesia for abdominal surgeries is possible and should be considered for patients that are at risk of side effects of opioids. However, it may not be possible to avoid opioids completely after the operation, especially if there are contraindications to other modalities of analgesia.