Opioid-Free Anesthesia Management in a Patient with Fentanyl Allergy Undergoing Laparoscopic Appendectomy: A Case Report

Abstract

Laparoscopic appendectomy is a routine procedure for acute appendicitis, traditionally managed with opioid analgesics like Fentanyl. However, opioid allergies present significant challenges in anesthesia management. This case report discusses the successful application of Opioid-Free Anesthesia (OFA) in a 19-year-old female patient with a known Fentanyl allergy. The patient developed an allergic reaction after receiving Fentanyl in the Emergency Room. Consequently, an OFA approach was adopted for her laparoscopic appendectomy. The anesthesia regimen included Dexmedetomidine, Lidocaine, Propofol, and Rocuronium for induction, with sevoflurane for maintenance and multimodal analgesia using Perfalgan and Dynastat. The patient’s intraoperative hemodynamics remained stable, and she was smoothly extubated post-surgery. Postoperatively, she experienced no pain, nausea, or vomiting and was discharged from the PACU with stable vital signs. This case underscores the feasibility and effectiveness of OFA in managing patients with opioid allergies, ensuring safe and effective perioperative outcomes.

Keywords: allergic reaction management, dexmedetomidine, multimodal analgesia, non-opioid anesthesia, perioperative management