Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies

Hung, Kuo‐Chuan; Chiu, Chong‐Chi; Hsu, Chih‐Wei; Lin, Chien‐Ming; Liao, Shu-Wei; Teng, I-Chia; Chen, I.-Wen; Wu, Shao-Chun

doi:10.1007/s11695-022-06213-7

Cited by 30 publications

(29 citation statements)

References 57 publications

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“…Opioids are often used to treat pain after LSG, but their use can result in opioid-induced nausea and vomiting. Administration of opioids raises the risk of PONV through increased vestibular system sensitivity and direct stimulation of the mu and delta opioid receptors in the brain stem chemoreceptor trigger zone [26] . The PONV can result in problems such as aspiration, wound dehiscence, pneumothoraxes, and prolonged duration in PACU [26] .…”

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Rashad,

el hefnawy,

Elmorshedi

et al. 2024

Ain-Shams Journal of Anesthesiology

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Background: This study aimed to compare the efficacy and safety of combined intraoperative tramadol with pethidine versus pethidine alone and to assess their impact on post-operative pethidine requirements after laparoscopic sleeve gastrectomy (LSG). Methods and Results:This multicenter cohort research included 400 patients with morbid obesity who had LSG between January 2021 and December 2022. The patients included in the study were allocated to one of two treatment groups that were not randomized. Group A received only 1 mg/kg of pethidine before extubation. , while Group B got 1 mg/kg tramadol given when the surgeon started a gastric division with 1 mg/kg of pethidine before extubation. Doses were based on the patient's ideal body weight.The mean VAS pain score at 1, 3, 6, 12, and 24h after LSG was significantly reduced in group B (4.2, 2.89, 2.03, 1.69, and 0.26, respectively) compared to group A (5.1, 4.16, 3.21, 2.78, and 0.44). Postoperative nausea and vomiting (PONV) were higher in group A at 3 and 6 h after LSG. Opioid consumption in the postoperative period was less in Group B than in Group A. There was a significant reduction in the requirement for on-demand metoclopramide and ondansetron in group B. Oxygen desaturation (<92) significantly developed in group A after surgery and was managed using an oxygen mask. Post-operative bradycardia was significantly observed in group B after LSG. Conclusion: Intraoperative tramadol with pethidine provides superior post-operative analgesia and safety over Intraoperative pethidine alone.

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Section: Discussionmentioning

confidence: 99%

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Rashad,

el hefnawy,

Elmorshedi

et al. 2024

Ain-Shams Journal of Anesthesiology

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“…Although there are still some controversies about the wide application of OFA in the clinic ( 37 ), we also see that this technology has been widely applied to the clinical practice of BS, general surgery, bone and spinal surgery, cesarean section and other operations ( 24 – 26 , 38 – 41 ). The application of OFA in obesity showed that it is a safe, feasible and well-tolerated therapy, which may offer a novel and well-tolerated treatment in morbid obesity patients ( 42 , 43 ).…”

Section: Discussionmentioning

confidence: 99%

Is esketamine-based opioid-free anesthesia more superior for postoperative analgesia in obstructive sleep apnea patients undergoing bariatric surgery? A study protocol

Guo

Chen²,

Gao³

et al. 2022

Front. Med.

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IntroductionOpioid-free anesthesia (OFA) can certainly prevent nausea and vomiting after bariatric surgery (BS), but its postoperative analgesic effect is still controversial. Obstructive sleep apnea (OSA) is a prominent feature of morbid obesity in BS and accounts for a very high proportion, which significantly increases the difficulty of patients’ airway management. Those patients will be more representative and highlight the advantages of OFA. It is not clear whether esketamine can play a more prominent role in OFA for postoperative analgesia. Therefore, this study aims to explore the postoperative analgesic effect of esketamine-based OFA on BS patients with OSA.Methods and analysisThis single-center, prospective, randomized, controlled, single-blind study is planned to recruit 48 participants to undergo BS from May 2022 to April 2023. Patients will be randomly assigned to the OFA group and opioid-based anesthesia (OBA) group in a ratio of 1:1. The primary outcome is the Numeric Rating Scale (NRS) at different times postoperatively. Secondary outcomes include analgesic intake, the incidence and severity of postoperative nausea and vomiting (PONV), Leiden Surgical Rating Scale (L-SRS), postoperative agitation and chills, PACU stay time, EuroQol five-dimensional questionnaire (EQ-5D), length of hospital stay, intraoperative awareness, and hemodynamically unstable treatments.DiscussionThe results of this study may explain the analgesic effect of esketamine-based OFA on patients undergoing BS combined with OSA, and provide evidence and insight for perioperative pain management.Ethics and disseminationThis study is initiated by the Ethics Committee of The First Affiliated Hospital of Shandong First Medical University [YXLL-KY-2022(035)]. The trial results will be published in peer-reviewed journals and at conferences.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT05386979], identifier [NCT 05386979].

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“…Consider utilizing preoperative non opioid oral analgesics as they are cost effective, in nonbariatric procedures or whenever applicable. Regional techniques should be considered when possible [6,8,19].…”

Section: Preemptive Analgesiamentioning

confidence: 99%

Obesity and anesthesia

Arora,

Sharma,

Carillo

2024

Current Opinion in Anaesthesiology

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Purpose of review Surgical procedures on obese patients are dramatically increasing worldwide over the past few years. In this review, we discuss the physiopathology of predominantly respiratory system in obese patients, the importance of preoperative evaluation, preoxygenation and intraoperative positive end expiratory pressure (PEEP) titration to prevent pulmonary complications and the optimization of airway management and oxygenation to reduce or prevent postoperative respiratory complications. Recent findings Many patients are coming to preoperative clinic with medication history of glucagon-like-peptide 1 agonists (GLP-1) agonists and it has raised many questions regarding Nil Per Os (NPO)/perioperative fasting guidelines due to delayed gastric emptying caused by these medications. American Society of Anesthesiologists (ASA) has come up with guiding document to help with such situations. Ambulatory surgery centers are doing more obesity cases in a safe manner which were deemed unsafe at one point. Quantitative train of four (TOF) monitoring, better neuromuscular reversal agents and gastric ultrasounds seemed to have made a significant impact in the care of obese patients in the perioperative period. Summary Obese patients are at higher risk of perioperative complications, mainly associated with those related to the respiratory function. An appropriate preoperative evaluation, intraoperative management, and postoperative support and monitoring is essential to improve outcome and increase the safety of the surgical procedure.

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Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies

Cited by 30 publications

References 57 publications

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Is esketamine-based opioid-free anesthesia more superior for postoperative analgesia in obstructive sleep apnea patients undergoing bariatric surgery? A study protocol

Obesity and anesthesia

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