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Background and Aims Αnalgesia for maxillofacial fractures surgery is mostly based on intravenous opioids while pain management postoperatively is often inadequate. With this case series we aimed to observe the efficacy of Opioid Free Analgesia (OFA) in three patients with maxillofacial bone fractures.

Methods Dexmedetomidine or clonidine was given as premedication and induction of general anesthesia consisted of lidocaine, dexmedetomidine and propofol. Moreover, maintenance of anesthesia and analgesia included lidocaine, dexmedetomidine and ketamine, paracetamol, NSAID, magnesium and dexamethasone. Postoperative analgesia regime included paracetamol and tramadol as rescue analgesia.The intraoperative analgesia was evaluated with the use of NOL monitor (Nociception Level) as well as with vital signs (Blood pressure, Heart rate, Anesthesia depth, EtCO2). Postoperative analgesia was assessed by NRS (Numerical Ratings Scales) and vital signs.

Results All three patients were men, 27-43 years old and ASA I or II. Their maximum Mean Arterial Pressure (MAP) intraoperatively was 106-120 mmHg, maximum Heart Rate (HR) 86-105 bpm and maximum NOL rate 23-42, all recorded during either intubation or first incision. Otherwise their MAP was kept below 95 mmHg, their HR < 83 bpm and their NOL rate < 20. During the first 36 hours postoperatively, all patients had an NRS score 0-1/10, MAP < 87 mmHg, HR < 80 bpm and only one of them required rescue analgesia.

Conclusions In this case series, we observed that OFA could achieve the analgesic goals in maxillofacial fractures surgery. Further studies are required to support our observation.