ketamine + fentanyl + lidocaine + magnesium + clonidine + remifentanil

This multi-modal opioid-sparing anesthesia protocol was developed by the University Hospital, Basel, for the management of surgical pain, particularly in patients undergoing laparoscopic surgery. The regimen combines low-dose mu-opioid receptor agonists (fentanyl and remifentanil) with several non-opioid adjuncts to achieve synergistic antinociception while minimizing opioid-related adverse effects. These adjuncts include ketamine (an NMDA receptor antagonist), lidocaine (a sodium channel blocker), magnesium (an NMDA antagonist and calcium channel blocker), and clonidine (an alpha-2 adrenergic receptor agonist). The protocol is typically administered intravenously alongside baseline hypnotics and muscle relaxants. Its clinical efficacy is often evaluated using the PMD-200 device, which monitors the Nociception Level (NOL) index to provide a physiological measure of the balance between nociceptive stimuli and analgesic coverage.

Other names

opioid-sparing anesthesia protocolopioid-sparing group-University Hospital, Basel, Switzerland-surgical pain