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Abstract

Background & objective: The number of bariatric surgeries is rapidly increasing the world over, and the concept of fast-track surgery using laparoscopy has made bariatric surgeries a cost-effective and efficient way of treating morbidly obese patients. It has been recommended to encourage opioid free anesthesia (OFA) using non-opioid analgesics during bariatric surgery for enhanced recovery. We compared general anesthesia (GA) employing opioids with OFA in laparoscopic bariatric surgeries.
Methodology: This prospective, double-blinded, randomized controlled study compared opioid-free anesthesia with traditional opioid-based methods in 50 adult patients, ASA I and II, scheduled for non-emergency laparoscopic weight reduction procedures. Patients were randomized as 25 patients to each group: Group A patients were managed with a non-opioid regimen, while Group B was managed with opioid-based regimen. All patients received ranitidine 50 mg and metoclopramide 10 mg IV.
Results: Non-significant differences were noted between the two groups regarding heart rate, blood pressure, EtCO₂ levels, or peak inspiratory pressure (P > 0.05). Nonetheless, the group that did not receive opioids had a notably slower recovery (P < 0.05). Patients in the opioid group reported higher pain score levels, measured by the Visual Analog Scale (VAS), immediately after surgery and within the first two hours (P < 0.05). The OFA Group required extended PCA usage and received fewer supplemental narcotic doses in contrast to the opioid group (P < 0.001). A higher frequency of nausea and vomiting postoperatively was significantly increased in the opioid group (P < 0.05). No notable differences were seen regarding cases of shivering or bradycardia (P > 0.05).
Conclusion: Opioid-free anesthetic protocol in conjugation with multimodal non-opioid drugs is effective for laparoscopic bariatric surgeries and supports enhanced recovery, compared to opioid based anesthesia. Frequency of postoperative nausea and vomiting was significantly increased in the opioid group.
Abbreviations: BIS: Bispectral Index, ERAS: Enhance Recovery After Surgery, EtCO₂: End tidal carbon dioxide. GA: general anesthesia, OBA: opioid-based anesthesia, OFA: Opioid-free Anesthesia, PCA: patient controlled analgesia, VAS: Visual Analog Scale,
Keywords: bariatric procedures, enhanced recovery, laparoscopic surgery, multimodal analgesia, Opioid free anesthesia
Citation: Nassar HNS, Zidan MM, Abdellatif SA, El Hennawy AME, Hussien RM. Comparative study between opioid usage and opioid free anesthesia in laparoscopic bariatric surgeries. Anaesth. pain intensive care 2025;29(5):288-298. DOI: 10.35975/apic.v29i5.2487
Received: April 16, 2024; Revised: May 20, 2025; Accepted: May 16, 2025