Total Intravenous Anaesthesia (TIVA) is a technique of general anaesthesia which uses a combination of agents given exclusively by the intravenous route without the use of inhalation agents. Till recently, inhalational anaesthetic agents have remained the routine choice for maintenance of anaesthesia, but they have their own drawbacks and shortcomings such as cost, different specific vaporizers which require repeated maintenance and scavenging system to prevent pollution of operation room.¹ However, in terms of global warming potential, inhalational anaesthetic agents still remain a big hazard for the environment.² Apart from avoiding these, TIVA decreases post-operative nausea and vomiting (PONV), lessens neurohumoral response, avoids distension of air-filled spaces and postoperative diffusion hypoxemia.¹

Opioids are very commonly used in modern methods of anaesthesia. The use of opioids is based on their ability to provide analgesia during the peri operative period.³ Opioids used as the part of a balanced anaesthesia are known to have a lot of side effects such as sedation, respiratory depression, post-operative nausea and vomiting, urinary retention, constipation and opioid induced hyperalgesia.⁴ These side effects can delay post-operative recovery and early mobilization of the patient. Apart from this opioid are also known for their physical dependence.

Opioid free total intravenous anaesthesia provides a viable alternative for these problems.

The principle of opioid free anaesthesia is to gain analgesic effects from different drugs while minimizing side effects particularly those of opioids,⁵ with added advantages of decreased postoperative nausea and vomiting and analgesic requirement post operatively.

Ketamine, an NMDA antagonist and dexmedetomidine, an alpha 2 adrenoreceptor agonist have been used in lieu of opioids to provide analgesia intraoperatively. Their use has strengthened the role of opioid free TIVA for maintenance of anaesthesia.