The Performance of Opioid-Free Anesthesia for Bariatric Surgery in Clinical Practice

Abstract

Purpose Opioid-free anesthesia (OFA) is an alternative to conventional opioid-based anesthesia (OBA) in patients undergoing bariatric surgery. Several small studies and a meta-analysis have suggested advantages of OFA for bariatric surgery, but current evidence is still contradictory, and a universally accepted concept has not yet been established. The purpose of this study was to determine whether patients undergoing bariatric surgery experience less postoperative pain and better postoperative recovery when anesthetized with an OFA regimen than with an OBA regimen. Materials and Methods This prospective observational cohort study, conducted between October 2020 and July 2021, compared patients receiving OFA with patients receiving OBA. Patients were visited 24 and 48 h after the surgical procedure and asked about their postoperative pain using the visual analogue scale (VAS). Additionally, the quality of recovery-40 questionnaire (QoR-40) and the postoperative opioid requirements were recorded. Results Ninety-nine patients were included and analyzed in this study (OFA: N = 50; OBA: N = 49). The OFA cohort exhibited less postoperative pain than the OBA cohort within 24 h (VAS median [interquartile range (IQR)]: 2.2 [1–4.4] vs. 4.1 [2–6.5]; P ≤ 0.001) and 48 h (VAS median [IQR]: 1.9 [0.4–4.1] vs. 3.1 [1.4–5.8]; P ≤ 0.001) postoperatively. Additionally, the OFA cohort had higher QoR-40 scores and required less opioid therapy postoperatively. Conclusion Based on our results the use of OFA for bariatric surgery results in less pain, reduced opioid requirements, and improved postoperative recovery—adding additional evidence regarding the use of OFA in everyday clinical practice. Graphical Abstract

Comparison between multimodal and intraoperative opioid free anesthesia for laparoscopic sleeve gastrectomy: a prospective, randomized study

“…Regarding the PONV rate, our study is in line with most studies 2 , 6 , 11 , 13 , 16 – 19 and meta-analysis 15 on OFA to show reduced incidence of PONV, to which opioid administration is the main factor. Avoiding opioids, even strictly intraoperatively, can positively impact the occurrence of PONV.…”

“…On the contrary, several trials revealed the superiority of OFA in this aspect. Ubing et al 16 found less opioid use in 48 h after the operation with significantly lower pain scores. The main difference that could contribute to these results is the continuous administration of the coanalgesics mixture in the recovery room, which may prolong the effects observed in our study only one hour after the operation.…”

Opioid-Free Anesthesia in Bariatric Surgery: Is It the One and Only? A Comprehensive Review of the Current Literature

“…In a study dedicated to bariatric surgery, dexmedetomidine was associated with meeting the discharge criteria faster in the recovery room; however, it was not associated with a reduction in the length of the hospital stay [ 48 ]. Similar results were obtained by Ulbing et al, in whose study patients in the OFA group achieved a statistically higher result in the subjective assessment of recovery using the QoR-40 form 24 and 48 h after surgery, but this was not associated with a shortened hospital stay [ 15 ]. On the contrary, in the trial by Clanet et al, no statistically significant difference between the QoR-40 questionnaire results was obtained 24 and 30 days after the surgery [ 13 ].…”

“…Opioid use is one of the few modifiable factors of PONV, especially as its incidence is dose-dependent [ 51 ]. There is clear evidence of a reduction in the prevalence of this complication in patients undergoing laparoscopic bariatric surgery, demonstrated in prospective trials [ 7 , 9 , 11 , 13 , 14 , 15 ] and in a meta-analysis dedicated to this group of patients in comparison to the anesthesia with multimodal analgesia group [ 52 ]. Still, there are discrepancies regarding the duration of the beneficial effect.…”

“…A possible explanation for this difference may be the fact that drugs used in OFA have a half-life of several hours, and their effects subside shortly after the cessation of their infusion [ 56 , 60 ]. One of the few studies with the continuation of the coanalgesics in the postoperative period is the work of Ulbing et al, which demonstrated a lower opioid consumption and a lower VAS pain score in the OFA group [ 15 ]. Maintaining the infusion of these drugs may be critical to achieving the clinical significance of the benefits of OFA in bariatric procedures.…”