Bariatric Surgery, Obesity, Opioid-free Anesthesia, Postoperative Pain
Conditions
Keywords
Opioid-Free Anesthesia, Bariatric Surgery, opioid-based anesthesia, morphine consumption, TIVA, multimodal analgesia
Brief summary
This study compares two different anesthesia techniques in patients with obesity undergoing bariatric surgery: one that includes opioids (OBA), and one that avoids them completely (OFA). The main goal is to determine whether avoiding opioids during surgery leads to lower postoperative morphine requirements and fewer side effects. Researchers reviewed medical records of 70 patients who had bariatric surgery between June 2022 and December 2023 at a hospital in Spain. The study evaluates pain levels, sedation, complications, and total morphine use in the first 48 hours after surgery.
Detailed description
This is a single-center, retrospective, observational cohort study conducted at Hospital HM Nou Delfos (Barcelona, Spain). The aim is to compare postoperative opioid requirements and outcomes in patients with morbid obesity undergoing laparoscopic bariatric surgery, according to the intraoperative anesthesia technique used. Two anesthetic strategies were evaluated: Opioid-Free Anesthesia (OFA): Total intravenous anesthesia (TIVA) without opioids, using agents such as propofol, ketamine, dexmedetomidine, lidocaine and magnesium. Opioid-Based Anesthesia (OBA): TIVA including opioids, following institutional standards. Medical records of 70 patients (35 in each group) who underwent surgery between June 2022 and December 2023 were analyzed. Key data extracted included demographics, surgical duration, anesthetic drugs used, intraoperative complications, pain scores (VAS at 1, 2, 4, 24, and 48 hours), sedation levels (RAMSAY scale), adverse effects (e.g., nausea, vomiting, ileus, hypotension), and morphine consumption. The primary outcome is total morphine use within the first 48 hours postoperatively. Secondary outcomes include pain scores, adverse events, time to awakening, and hospital length of stay. Statistical analysis was performed using descriptive and inferential methods, including regression models adjusted for age, sex, BMI, and comorbidities. This study provides real-world evidence on the clinical impact of opioid-free anesthesia in bariatric patients, aiming to improve perioperative safety and enhance postoperative recovery.
Interventions
None listed
Sponsors
Hospital HM Nou Delfos
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Age between 18 and 65 years Body Mass Index (BMI) ≥ 30 kg/m² ASA physical status II or III Underwent laparoscopic bariatric surgery under general anesthesia at HM Nou Delfos Surgery performed between June 1, 2022 and December 31, 2023
Exclusion criteria
Pregnancy or breastfeeding Chronic pain patients on high-dose opioids Known allergy to any anesthetic drug used in the study Severe hepatic (e.g., cirrhosis with portal hypertension) or renal insufficiency Untreated coagulopathy Active alcohol or drug abuse Uncontrolled or severe psychiatric illness Intraoperative complications requiring deviation from planned anesthetic technique Postoperative morphine use exceeding institutional norms for bariatric surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total postoperative morphine consumption (mg) | From 0 to 48 hours after surgery | Cumulative amount of morphine (in milligrams) administered within the first 48 hours after surgery, as recorded in the post-anesthesia care unit and inpatient medical records. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity (VAS) | At 1, 2, 4, 24, and 48 hours postoperatively | Pain evaluated using the Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst imaginable pain), both at rest and with movement. |
| Sedation level (RAMSAY scale) | From 0 to 48 hours after surgery | Sedation assessed using the Ramsay Sedation Scale, ranging from 1 (anxious/agitated) to 6 (no response to stimuli). |
| Incidence of adverse events | Up to 48 hours after surgery | Number of patients experiencing side effects such as nausea, vomiting, pruritus, hypotension, bradycardia, ileus, or urinary retention. |
| Length of hospital stay | From surgery until discharge (up to 7 days) | Total duration of hospital stay in days, calculated from the day of surgery to discharge date. |
| Time to awakening | Intraoperative period until recovery (measured at end of surgery) | Time in minutes from the end of surgery until patient opens eyes or responds to verbal commands. |
Countries
Spain
Outcome results
None listed