Opioid-free anesthesia in bariatric surgery: a prospective randomized controlled trial

Bariatric surgeries are increasingly used to manage obesity, presenting significant perioperative challenges, especially with opioid use. Opioid-Free Anesthesia (OFA) is a multimodal technique to address these issues. This study aims to compare the effects of OFA and traditional Opioid-Based Anesthesia (OBA) on postoperative morphine consumption, hemodynamics, pain, postoperative nausea and vomiting (PONV), sedation, and patient satisfaction in bariatric surgery.

A prospective controlled study was conducted in the operating room of a tertiary university hospital. It included patients aged between 18 and 65 years undergoing bariatric surgery. 58 obese patients were divided into two groups: 32 received OBA and 26 received OFA. The OFA regimen included lidocaine, ketamine, magnesium sulfate, dexmedetomidine, and dexamethasone. Main outcome measures included postoperative morphine consumption in the Post-Anesthesia Care Unit (PACU), 24 and 48 h after surgery. Secondary outcomes included hemodynamic parameters, sedation score, pain score, presence of nausea and/or vomiting, and overall patient satisfaction evaluated at 48 h postoperatively or before hospital discharge were recorded.

OFA significantly reduced postoperative morphine consumption (median dose of 8 mg vs.19 mg, p = 0.000). Visual analogue scale (VAS) scores for pain at rest, during movement, and during coughing were significantly lower in the OFA group. Both groups were hemodynamically stable perioperatively. There was no significant difference in PONV incidence or sedation levels between the groups in the PACU, 24 and 48 h after surgery. Patient satisfaction was higher in the OFA group, with 65% reporting a satisfaction score of ≥ 8/10 compared to 28% in the OBA group.

OFA reduces postoperative morphine consumption and improves pain management without compromising hemodynamic stability or increasing sedation. Furthermore, the incidence of PONV was not significantly different and overall patient satisfaction was higher with OFA. These findings support the use of OFA in bariatric surgery, despite the need for further studies with larger sample sizes.