Abstract
This prospective randomized controlled trial compared opioid-sparing multimodal analgesia with conventional opioid analgesia in 130 patients undergoing laparoscopic radical gastrectomy, with 65 patients allocated to each group. Gastrointestinal motility was assessed using cine-MRI at 24, 48, and 72 h after surgery. Postoperative ileus (POI) occurred in 6/65 patients (9.2%) in the opioid-sparing group and 17/65 (26.2%) in the conventional group. The between-group comparison yielded a two-sided Fisher exact p = 0.0201, an unadjusted risk ratio of 0.35 (95% CI, 0.15-0.84), and a risk difference of -16.9 percentage points. Cine magnetic resonance imaging (Cine-MRI) contraction frequency, contraction amplitude, and motility scores were higher in the opioid-sparing group across postoperative assessments. The opioid-sparing group also had lower opioid exposure and pain scores and shorter gastrointestinal recovery times. These findings support the use of multimodal opioid-sparing analgesia as a perioperative strategy after laparoscopic gastrectomy and demonstrate the potential value of cine-MRI for dynamic assessment of postoperative gastrointestinal motility.