bupivacaine + lidocaine + ketamine

This multi-modal, opioid-free anesthetic (OFA) regimen was developed and studied by the Medical University of Silesia for the management of acute intraoperative and postoperative pain in patients undergoing thoracic surgery. The regimen is designed to provide effective analgesia while mitigating the respiratory complications and other adverse effects typically associated with opioid-based anesthesia in this clinical setting. It consists of a regional anesthetic component—a single-shot thoracic paravertebral block (ThPVB) using **bupivacaine**—combined with systemic non-opioid analgesics administered intravenously, specifically **lidocaine** and **ketamine**. Bupivacaine and lidocaine function as local anesthetics by blocking voltage-gated sodium channels, thereby inhibiting the initiation and conduction of nerve impulses. Ketamine acts as a non-competitive antagonist at the N-methyl-D-aspartate (NMDA) receptor, providing potent analgesia and preventing central sensitization. This combination was evaluated in a randomized controlled trial (NCT04141306) against standard opioid-based anesthesia using fentanyl.

Other names

Opioid-free anesthesiaOFAOpioid-free anesthesia (Medical University of Silesia)ThPVB + lidocaine + ketamine