1
|
Olausson A, Jildenstål P, Andréll P, Angelini E, Stenberg E, Wallenius V, Öhrström H, Thörn SE, Wolf A. Effects of an opioid-free care pathway vs. opioid-based standard care on postoperative pain and postoperative quality of recovery after laparoscopic bariatric surgery: A multicentre randomised controlled trial. Eur J Anaesthesiol 2025:00003643-990000000-00298. [PMID: 40371564 DOI: 10.1097/eja.0000000000002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
BACKGROUND Opioid-free anaesthesia (OFA) may enhance postoperative recovery after bariatric surgery, but its combined effect with opioid-free interventions has not been studied. OBJECTIVES To compare postoperative pain and recovery after laparoscopic bariatric surgery with a total opioid-free care pathway and conventional opioid-based treatment. DESIGN A multicentre nonblinded controlled trial. SETTING Two university hospitals in Sweden. PATIENTS Adult patients scheduled for laparoscopic bariatric surgery were enrolled between May 2019 and November 2023. Of 837 patients screened, 112 were randomised, and 110 were included in the analysis: 55 in the intervention and 55 in the control group. INTERVENTIONS Patients were randomised to an opioid-based standard care (control group) or to an opioid-free care pathway (intervention group), including intraoperative OFA and postoperative first-line transcutaneous electrical nerve stimulation (TENS) treatment. MAIN OUTCOME MEASURES The primary outcome was the change in patient-reported postoperative pain intensity on a numerical rating scale (NRS) from arrival in the postanaesthesia care unit (PACU) until discharge to the surgical ward. Key secondary outcomes were postoperative pain intensity, in-hospital opioid consumption, and postoperative quality of recovery scale (PQRS) scores. RESULTS There was no difference between the groups regarding the changes in pain intensity from arrival in PACU until discharge to the ward, with mean ± SD changes in NRS of 3.20 ± 3.01 (intervention) vs. 3.15 ± 2.25 (control); mean difference (MD) 0.04 [(95% confidence interval (CI), -1.00 to 1.08); P = 0.97], and pain intensity at 24 h (P = 0.078), 72 h (P = 0.060), and 3 months (P = 0.30) postoperatively. The intervention group had a significantly lower opioid consumption in the PACU; mean morphine equivalents 6.08 ± 12.31 vs. 51.1 ± 14.9 mg; MD -45.0 (95% CI, -50.1 to -39.8) mg; P < 0.0001; and during the hospital stay MD -40.3 (95% CI, -54.4 to -25.9) mg; P < 0.0001. Total PQRS scores did not differ significantly over the 3-month follow-up. CONCLUSION The opioid-free care pathway offers patients pain relief and recovery outcomes comparable to conventional opioid-based care and reduces opioid use after laparoscopic bariatric surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT03756961.
Collapse
Affiliation(s)
- Alexander Olausson
- From the Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg (AO, PJ, EA, AW), Department of Health Sciences, Lund University (PJ), Department of Anesthesiology and Intensive Care, Skåne University Hospital, Lund (PJ), Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (PA, S-ET), Department of Anaesthesiology and Intensive Care Medicine/Pain Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg (PA), Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro (ES), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg (VW), Department of Surgery, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg (VW), Department of Anesthesiology and Intensive Care, Örebro University Hospital, Region Örebro län, Örebro (HÖ), Department of Anesthesiology and Intensive Care, Lindesberg Hospital, Region Örebro län, Lindesberg (HÖ), Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital/Östra, Region Västra Götaland, Gothenburg, Sweden (S-ET, AW), Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway (AW) and Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden (AW)
| | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Neishaboury M, Shokri S, Kianpour P, Farhadi K, Najjari K, Sharifnia H, MohammadYousef R, Khajavi M. The Effects of Intraperitoneal Dexmedetomidine in Comparison with Ropivacaine in Postoperative Pain After Laparoscopic Sleeve Gastrectomy: A Double-Blind, Randomized, Placebo-Controlled, Clinical Trial. Obes Surg 2025:10.1007/s11695-025-07871-z. [PMID: 40281250 DOI: 10.1007/s11695-025-07871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 04/04/2025] [Accepted: 04/10/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND Studies have shown that non-opioid analgesic drugs can reduce the pain of patients after bariatric surgery. Ropivacaine and dexmedetomidine are associated with high efficacy and safety in managing postoperative complications. We evaluated the effectiveness of ropivacaine alone and in combination with dexmedetomidine in improving outcomes after sleeve gastrectomy surgery. METHODS This double-blind, randomized clinical trial, included patients undergoing bariatric surgery in 2022 and 2023. The participants were randomly divided into three groups: treated with ropivacaine alone (group A), ropivacaine and dexmedetomidine combination (group B), or normal saline (group C). Pain scores, morphine consumption, and postoperative nausea and vomiting (PONV) were assessed over 24 h. RESULTS All groups showed reduced pain, but group B had significantly lower VAS scores than groups A and C at 4-24 h postoperatively, with the highest difference achieved by group B compared to control at 12-h time point (β = - 2.5, P < 0.001). Morphine use was lowest in group B (4.38 ± 1.24 mg vs. 6.04 ± 2.07 mg in group A and 7.50 ± 2.55 mg in group C; P < 0.001). PONV incidence was also lower in group B (8.3% vs. 29.2% in group A and 50% in group C; P = 0.008). CONCLUSIONS The ropivacaine and dexmedetomidine combination therapy was associated with a greater pain relief effect after sleeve gastrectomy, a greater reduction in the need to take opioids, and a lower frequency of PONV compared to the ropivacaine alone or placebo.
Collapse
Affiliation(s)
- Mohamadreza Neishaboury
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Samira Shokri
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Parisa Kianpour
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of.
| | - Kousha Farhadi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Khosrow Najjari
- Department of General Surgery, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Hamidreza Sharifnia
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Rana MohammadYousef
- Department of Anesthesiology and Critical Care, School of Medicine, Childrens Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of
| | - Mohammadreza Khajavi
- Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Tehran, Iran, Islamic Republic of.
| |
Collapse
|
3
|
Lopes CM, Cotian LFP, Schaefer JL. Multidisciplinary Approach on Metabolic Bariatric Surgery Evasion: Analysis of Predictors and Potential Influencing Factors in the Preoperative Period. Obes Surg 2025; 35:1525-1537. [PMID: 40088363 DOI: 10.1007/s11695-025-07783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 02/08/2025] [Accepted: 03/01/2025] [Indexed: 03/17/2025]
Abstract
This study aims to identify evasion predictors and factors in the preoperative period of metabolic bariatric surgery (MBS) through a review and evaluations of professionals involved, as well as patient knowledge and information, aiming at positive long-term results. This article performed a systematic literature review (SLR) in the PubMed, Scopus, and Web of Science databases. It used the PRISMA Protocol with a record of 7 years to obtain documents published a year before the pandemic, during and after it. The search strategy resulted in 4649 records, of which 51 studies were included in the review. Subsequently, an analysis was carried out in which the professionals who met the patient participated in a qualitative survey, in which the results were analyzed and compared to those obtained in the SLR. The decision to undergo MBS is influenced by fears, uncertainties, and the need for support, particularly for elderly patients. Health professionals are crucial in providing continuous guidance and support throughout the process.
Collapse
|
4
|
Contreras Pérez G, Frederico Avendaño C, Cortínez LI, Giménez Crouseilles J, Carví Mallo A. The Postoperative Lidocaine and Ketamine Effects on Morphine Requirement in Bariatric Surgery. Obes Surg 2025; 35:1265-1272. [PMID: 40095182 DOI: 10.1007/s11695-025-07689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 01/06/2025] [Accepted: 01/11/2025] [Indexed: 03/19/2025]
Abstract
BACKGROUND Effective postoperative pain management in patients with obesity undergoing metabolic bariatric surgery is challenging due to the adverse effects associated with opioid use. Multimodal analgesic approaches during the intraoperative period have been shown to effectively reduce postoperative opioid consumption. This study evaluated the impact of prolonged postoperative lidocaine and ketamine infusion for 90 min on postoperative morphine consumption as a complementary multimodal analgesic approach. METHODS This retrospective cohort study included 64 patients who underwent elective sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). Thirty-two patients who received lidocaine and ketamine infusions postoperatively (group A) were compared with 32 patients who received standard postoperative analgesia (group B). The primary outcome measured was total morphine consumption within the first 48 h post-surgery. Pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 24, and 48 h post-surgery. RESULTS Mean cumulative morphine consumption at 48 h was 0.82 ± 1.55 mg in group A versus 2.03 ± 2.61 mg in group B (p = 0.0696). In total, 62.5% of patients did not require morphine during the first 48 postoperative hours. VAS scores were significantly lower in group A at four postoperative hours (1.03 ± 1.36) compared to group B (2.16 ± 1.65) (p = 0.0024). CONCLUSIONS Postoperative morphine consumption and pain scores were low in the current multimodal analgesic approach. Prolonging lidocaine and ketamine infusion for 90 min postoperatively was not justified based on the current results.
Collapse
|
5
|
Ao Y, Ma J, Zheng X, Zeng J, Wei K. Opioid-Sparing Anesthesia Versus Opioid-Free Anesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis. Anesth Analg 2025; 140:385-396. [PMID: 38578868 DOI: 10.1213/ane.0000000000006942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Patients who undergo laparoscopic bariatric surgery (LBS) are susceptible to postoperative nausea and vomiting (PONV). Opioid-free anesthesia (OFA) or opioid-sparing anesthesia (OSA) protocols have been proposed as solutions; however, differences between the 2 alternative opioid protocols for anesthesia maintenance in obese patients remain uncertain. A network meta-analysis was conducted to compare the impacts of OFA and OSA on PONV. METHODS Systematic searches were conducted using Embase, PubMed, MEDLINE, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing OFA and OSA strategies. After screening according to the inclusion and exclusion criteria, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the credibility of the evidence. The main concern of this review was the difference between OFA and OSA in reducing PONV. The primary outcome was any PONV occurrence within 24 hours. Secondary outcomes included postoperative pain intensity, opioid consumption, opioid-related adverse events, and length of hospital stay. RESULTS Fifteen RCTs involving 1310 patients were identified for a network meta-analysis from 1776 articles that compared OFA, OSA, and traditional opioid-based anesthesia (OBA) strategies in LBS. Twelve RCTs (80%) with 922 participants (70%) were eligible for the occurrence of PONV. These included 199 (22%) patients who received OFA and 476 (52%) and 247 (27%) patients who received OSA and OBA, respectively. OFA was more effective at reducing PONV (relative risks [RR], 0.6, 95% confidence interval [CI], 0.5-0.9, moderate-quality evidence) compared to OSA. No differences were observed in postoperative pain control or opioid consumption between the OFA and OSA strategies (very low-to high-quality evidence). Notably, OFA is associated with a higher risk of bradycardia than OSA (RR, 2.6, 95% CI, 1.2-5.9, moderate-quality evidence). CONCLUSIONS OFA is more effective than OSA in reducing the occurrence of PONV during the early postoperative period of LBS, although it may associate with an increased risk of bradycardia. Patients who received either opioid-alternative strategy demonstrated similar effects in reducing postoperative opioid consumption and alleviating pain intensity.
Collapse
Affiliation(s)
- Yichan Ao
- From the Departments of Anesthesiology
| | | | - Xiaozhuo Zheng
- Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Wei
- From the Departments of Anesthesiology
| |
Collapse
|
6
|
Wang JC, Wang L. Correct understanding and intervention of postoperative nausea and vomiting can provide reference for clinical practice. World J Gastrointest Surg 2024; 16:3658-3662. [PMID: 39734467 PMCID: PMC11650253 DOI: 10.4240/wjgs.v16.i12.3658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 10/12/2024] [Accepted: 10/24/2024] [Indexed: 11/27/2024] Open
Abstract
In this editorial, we reviewed the article by Li et al. We aimed to explore various perspectives to further mitigate the risk factors for postoperative nausea and vomiting (PONV), which could significantly reduce its incidence and related postoperative complications. PONV is highly prevalent among patients undergoing bariatric surgery, yet there are relatively few related studies. Currently, the mainstream bariatric surgery methods include laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Despite the effectiveness of surgery in helping patients lose weight, postoperative PONV may occur, potentially leading to various complications (such as aspiration and wound dehiscence). A retrospective study by Li et al has compared the impact of different operative positions during laparoscopic sleeve gastroplasty on the incidence of PONV, providing new insights into the clinical practice aimed at reducing PONV incidence and thereby improving patient's postoperative experience.
Collapse
Affiliation(s)
- Jian-Chao Wang
- Department of Gastrointestinal Surgery Medical Center, Shandong Second Medical University, Weifang 261000, Shandong Province, China
| | - Liang Wang
- Department of Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University and Affiliated Cancer Hospital of Qinghai University, Xining 810000, Qinghai Province, China
| |
Collapse
|
7
|
Wong JH, Na Y, Parsa FD. Evolving Toward Non-narcotic Perioperative Enhanced Recovery After Surgery and Opioid-Free Analgesia in the Management of Postoperative Pain. Cureus 2024; 16:e76605. [PMID: 39881918 PMCID: PMC11775738 DOI: 10.7759/cureus.76605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2024] [Indexed: 01/31/2025] Open
Abstract
Opioid medications are commonly employed for perioperative and postoperative pain management. However, these medications can negatively impact the body's innate pain management system, specifically the action of beta-endorphins. By impairing the function of mu-opioid receptors and inhibiting the release of beta-endorphin, opioids may exacerbate and prolong postoperative pain. Additionally, opioid use is associated with numerous side effects, including nausea, vomiting, constipation, excessive sedation, clouded sensorium, dizziness, respiratory depression, and addiction, all of which may impede postoperative patient recovery and outcome quality. The purpose of this article is to explore the intricate relationship between opioid medications and endogenous beta-endorphins, examine nonopioid modalities for postoperative pain control, and elucidate the applications of non-narcotic perioperative enhanced recovery after surgery protocols in improving patient outcomes.
Collapse
Affiliation(s)
- Justin H Wong
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Yujin Na
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| | - Fereydoun D Parsa
- Department of Surgery, Division of Plastic Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, USA
| |
Collapse
|
8
|
da Silveira CAB, Rasador ACD, Medeiros HJS, Slawka E, Gesteira L, Pereira LC, Amaral S. Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis. Can J Anaesth 2024; 71:1466-1485. [PMID: 39500840 DOI: 10.1007/s12630-024-02831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 11/28/2024] Open
Abstract
PURPOSE Opioid anesthesia is commonly employed in minimally invasive surgeries but is associated with adverse effects, including postoperative nausea and vomiting (PONV). Opioid-free anesthesia aims to mitigate these issues. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing opioid and opioid-free anesthesia in minimally invasive abdominal surgeries. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for randomized controlled trials (RCTs) comparing these approaches. Our primary outcomes were adverse effects (PONV, bradycardia), while secondary outcomes were pain, opioid consumption, and postanesthesia care unit (PACU) length of stay (LOS). We performed a TSA to investigate the conclusiveness of the results. RESULTS We included 26 RCTs encompassing 2,025 patients, with 1,009 (49%) in the opioid-free anesthesia group. Opioid-free anesthesia reduced PONV significantly (risk ratio, 0.55; 95% confidence interval [CI], 0.40 to 0.74; P < 0.001), but we found no significant differences in bradycardia rates. We found nonclinically relevant higher pain scores for opioid anesthesia (mean difference [MD], -0.9; 95% CI, -1.7 to -0.2; P = 0.01) and opioid consumption at 2 hr post surgery (MD, -5.4 mg oral morphine equivalents; 95% CI, -9.1 to -1.8; P = 0.004). We also noted a reduced time to first analgesia (MD, 88 min; 95% CI, 18 to 159; P = 0.01). We found no differences in PACU LOS. The TSA confirmed the sample size's adequacy in showing PONV reduction with opioid-free anesthesia. CONCLUSION Opioid-free anesthesia showed a significant reduction in PONV and a decrease in opioid consumption during the first 2 hr postoperatively, suggesting it can be an alternative to opioid anesthesia in minimally invasive abdominal surgeries. STUDY REGISTRATION PROSPERO ( CRD42023492385 ); first submitted 18 December 2023.
Collapse
Affiliation(s)
| | - Ana C D Rasador
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Heitor J S Medeiros
- Department of Anesthesiology, Critical Care and Pain Medicine, Massachussets General Hospital, Boston, MA, USA
| | - Eric Slawka
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lucas C Pereira
- Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Sara Amaral
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27701, USA.
| |
Collapse
|
9
|
Budiansky A, Eipe N. Acute pain management in patients with severe obesity. BJA Educ 2024; 24:318-325. [PMID: 39234153 PMCID: PMC11368600 DOI: 10.1016/j.bjae.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 09/06/2024] Open
Affiliation(s)
| | - N. Eipe
- University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
10
|
Li S, Li H, Zhang R, Zhang F, Yin J, He L. Effect of modified opioid sparing anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery: protocol for a monocentre, double-blind randomised controlled trial - the MOSA study. BMJ Open 2024; 14:e086523. [PMID: 39059808 PMCID: PMC11284863 DOI: 10.1136/bmjopen-2024-086523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Obesity patients undergoing laparoscopic bariatric surgery (LBS) are frequently encountered perioperative adverse events related to opioids-based anaesthesia (OBA) or opioids-free anaesthesia (OFA). While modified opioid-sparing anaesthesia (MOSA) has been shown to lower the occurrence of adverse events related to OBA and OFA. This study is to assess the efficacy of MOSA in enhancing the recovery quality among individuals undergoing LBS. METHODS AND ANALYSIS A single-centre, prospective, double-blind, randomised controlled trial is conducted at a tertiary hospital. A total of 74 eligible participants undergoing elective LBS will be recruited and randomly allocated. Patients in the MOSA group will receive a combination of low-dose opioids, minimal dexmedetomidine, esketamine and lidocaine, while in the OBA group will receive standard general anaesthesia with opioids. Patients in both groups will receive standard perioperative care. The primary outcome is the quality of recovery-15 score assessed at 24 hours after surgery. Secondary outcomes include pain levels, anxiety and depression assessments, gastrointestinal function recovery, perioperative complication rates, opioid consumption and length of hospital stay. ETHICS AND DISSEMINATION Ethical approval has been provided by the Ethical Committee of Yan'an Hospital of Kunming City (approval No. 2023-240-01). Eligible patients will provide written informed consent to the investigator. The outcomes of this trial will be disseminated in a peer-reviewed scholarly journal. TRIAL REGISTRATION NUMBER The study protocol is registered at https://www.chictr.org.cn/ on 19 December 2023. (identifier: ChiCTR2300078806). The trial was conducted using V.1.0.
Collapse
Affiliation(s)
- Shikuo Li
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Honghao Li
- Anesthesiology Operating Center, Yan'an Hospital of Kunming City, Kunming, China
| | - Ruqiang Zhang
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Furong Zhang
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Jianwei Yin
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| | - Liang He
- Anesthesiology, Yan'an Hospital of Kunming City, Kunming, China
| |
Collapse
|
11
|
Perez JJ, Strunk JD, Preciado OM, DeFaccio RJ, Chang LC, Mallipeddi MK, Deal SB, Oryhan CL. Effect of an opioid-free anesthetic on postoperative opioid consumption after laparoscopic bariatric surgery: a prospective, single-blinded, randomized controlled trial. Reg Anesth Pain Med 2024:rapm-2024-105632. [PMID: 38839427 DOI: 10.1136/rapm-2024-105632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Opioid administration has the benefit of providing perioperative analgesia but is also associated with adverse effects. Opioid-free anesthesia (OFA) may reduce postoperative opioid consumption and adverse effects after laparoscopic bariatric surgery. In this randomized controlled study, we hypothesized that an opioid-free anesthetic using lidocaine, ketamine, and dexmedetomidine would result in a clinically significant reduction in 24-hour postoperative opioid consumption when compared with an opioid-inclusive technique. METHODS Subjects presenting for laparoscopic or robotic bariatric surgery were randomized in a 1:1 ratio to receive either standard opioid-inclusive anesthesia (group A: control) or OFA (group B: OFA). The primary outcome was opioid consumption in the first 24 hours postoperatively in oral morphine equivalents (OMEs). Secondary outcomes included postoperative pain scores, patient-reported incidence of opioid-related adverse effects, hospital length of stay, patient satisfaction, and ongoing opioid use at 1 and 3 months after hospital discharge. RESULTS 181 subjects, 86 from the control group and 95 from the OFA group, completed the study per protocol. Analysis of the primary outcome showed no significant difference in total opioid consumption at 24 hours between the two treatment groups (control: 52 OMEs vs OFA: 55 OMEs, p=0.49). No secondary outcomes showed statistically significant differences between groups. CONCLUSIONS This study demonstrates that an OFA protocol using dexmedetomidine, ketamine, and lidocaine for laparoscopic or robotic bariatric surgery was not associated with a reduction in 24-hour postoperative opioid consumption when compared with an opioid-inclusive technique using fentanyl.
Collapse
Affiliation(s)
- Josiah Joco Perez
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Joseph D Strunk
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Octavio M Preciado
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | | | - Lily C Chang
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Mohan K Mallipeddi
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Shanley B Deal
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Christine L Oryhan
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| |
Collapse
|
12
|
Arora L, Sharma S, Carillo JF. Obesity and anesthesia. Curr Opin Anaesthesiol 2024; 37:299-307. [PMID: 38573180 DOI: 10.1097/aco.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
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.
Collapse
Affiliation(s)
- Lovkesh Arora
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | |
Collapse
|
13
|
Olausson A, Angelini E, Heckemann B, Andréll P, Jildenstål P, Thörn SE, Wolf A. Patients' perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100201. [PMID: 38746814 PMCID: PMC11080373 DOI: 10.1016/j.ijnsa.2024.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients' perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway. OBJECTIVE We aimed to describe similarities and differences in patients' perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway. DESIGN A qualitative interview study. SETTING A strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management. PARTICIPANTS Twenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group. METHODS Semi-structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis. RESULTS The analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure. In Category 2, describing liminality of general anaesthesia, there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control, describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts, and the opioid-based group describing confidence in but awareness of opioids. Throughout the overall perioperative time period, participants acknowledged Category 4, a patient-professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication. CONCLUSIONS We highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.
Collapse
Affiliation(s)
- Alexander Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Angelini
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Birgit Heckemann
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine/Pain Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
- Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sven-Egron Thörn
- Sahlgrenska University Hospital/Östra, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra, Department of Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| |
Collapse
|
14
|
Mieszczański P, Kołacz M, Trzebicki J. Opioid-Free Anesthesia in Bariatric Surgery: Is It the One and Only? A Comprehensive Review of the Current Literature. Healthcare (Basel) 2024; 12:1094. [PMID: 38891169 PMCID: PMC11171472 DOI: 10.3390/healthcare12111094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Opioid-free anesthesia (OFA) is a heterogeneous group of general anesthesia techniques in which the intraoperative use of opioids is eliminated. This strategy aims to decrease the risk of complications and improve the patient's safety and comfort. Such potential advantages are particularly beneficial for selected groups of patients, among them obese patients undergoing laparoscopic bariatric surgery. Opioids have been traditionally used as an element of balanced anesthesia, and replacing them requires using a combination of coanalgesics and various types of local and regional anesthesia, which also have their side effects, limitations, and potential disadvantages. Moreover, despite the growing amount of evidence, the empirical data on the superiority of OFA compared to standard anesthesia with multimodal analgesia are contradictory, and potential benefits in many studies are being questioned. Additionally, little is known about the long-term sequelae of such a strategy. Considering the above-mentioned issues, this study aims to present the potential benefits, risks, and difficulties of implementing OFA in bariatric surgery, considering the current state of knowledge and literature.
Collapse
Affiliation(s)
- Piotr Mieszczański
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Lindleya 4 Str., 02-005 Warsaw, Poland; (M.K.); (J.T.)
| | | | | |
Collapse
|
15
|
Kavakli AS, Sahin T, Koc U, Karaveli A. Ultrasound-Guided External Oblique Intercostal Plane Block for Postoperative Analgesia in Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized, Controlled, Patient and Observer-Blinded Study. Obes Surg 2024; 34:1505-1512. [PMID: 38499943 PMCID: PMC11031435 DOI: 10.1007/s11695-024-07174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The external oblique intercostal plane (EOI) block is a novel block technique for anterolateral upper abdominal wall analgesia. The superficial nature of the external oblique intercostal plane allows it to be easily identified even in patients with obesity. The aim of this study was to test the hypothesis that EOI block would reduce IV morphine consumption within 24 h after laparoscopic sleeve gastrectomy. MATERIALS AND METHODS Patients were randomly assigned to one of two groups: EOI block group and control group. The patients in the EOI block group received ultrasound-guided bilateral EOI block with a total of 40 ml 0.25% bupivacaine after anesthesia induction. The patients in the control group received no intervention. Postoperatively, all the patients were connected to an intravenous patient controlled analgesia (PCA) device containing morphine. The primary outcome of the study was IV morphine consumption in the first postoperative 24 h. RESULTS The median [interquartile range] morphine consumption at 24 h postoperatively was significantly lower in the EOI block group than in the control group (7.5 [3.5 to 8.5] mg vs 14 [12 to 20] mg, p = 0.0001, respectively). Numerical rating scale (NRS) scores at rest and during movement were lower in the EOI block group than in the control group at 2, 6, and 12 h but were similar at 24 h. No block-related complications were observed in any patients. CONCLUSION The results of the current study demonstrated that bilateral EOI block reduced postoperative opioid consumption and postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05663658.
Collapse
Affiliation(s)
- Ali Sait Kavakli
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey.
- Istinye Universite Hastanesi, Aşık Veysel Mah, Süleyman Demirel Cd. No:1, 34517, Esenyurt, Istanbul, Turkey.
| | - Taylan Sahin
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey
| | - Umit Koc
- Department of General Surgery, Faculty of Medicine, Istinye University, 34396, Istanbul, Turkey
| | - Arzu Karaveli
- Department of Anesthesiology and Reanimation, University of Health Sciences, Antalya Training and Research Hospital, 07100, Antalya, Turkey
| |
Collapse
|
16
|
Zhang X, Chen XY, Gao RJ, Huang Y, Mao SM, Feng JY. The Effect of Depth of Anesthesia on Postoperative Pain in Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial. Obes Surg 2024; 34:1793-1800. [PMID: 38587781 PMCID: PMC11031442 DOI: 10.1007/s11695-024-07207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Patients with obesity are more sensitive to pain and more likely to have acute postoperative pain (APP). Studies have shown that the depth of anesthesia may affect the incidence of APP. The purpose of the study was to look into the connection between APP and depth of anesthesia in patients with obesity undergoing laparoscopic sleeve gastrectomy. METHODS This is a prospective, double-blinded randomized clinical trial, 90 patients undergoing laparoscopic sleeve gastrectomy were randomly divided into two groups: the light anesthesia group (Bispectral Index of 50, BIS 50) and the deep anesthesia group (BIS 35). The degree of pain was evaluated by the visual analogue scale (VAS) at 0, 12, 24, 48, and 72 h after surgery. The use of analgesics, grade of postoperative nausea and vomiting (PONV), and the Quality of Recovery-15 (QoR-15) score were recorded. RESULTS The VAS scores at rest or coughing at 0, 12, and 24 h after surgery in the BIS 35 group were lower than those in the BIS 50 group (P < 0.05). Fewer patients in the deep anesthesia group needed analgesia during the recovery period, and patient satisfaction was higher on the 3rd day after surgery (P < 0.015, P < 0.032, respectively). CONCLUSIONS For patients with obesity, maintaining a deeper depth of anesthesia during surgery is beneficial to reduce APP causes less need for additional analgesic drugs, and improves patient satisfaction.
Collapse
Affiliation(s)
- Xue Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Xin-Yue Chen
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Rui-Jia Gao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Yu Huang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Shi-Meng Mao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China
| | - Ji-Ying Feng
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, 222002, Jiangsu, China.
| |
Collapse
|
17
|
Doymus O, Ahiskalioglu A, Kaciroglu A, Bedir Z, Tayar S, Yeni M, Karadeniz E. External Oblique Intercostal Plane Block Versus Port-Site Infiltration for Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Study. Obes Surg 2024; 34:1826-1833. [PMID: 38565828 PMCID: PMC11031609 DOI: 10.1007/s11695-024-07219-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Although laparoscopic sleeve gastrectomy (LSG) is a minimally invasive surgery, postoperative pain is common. A novel block, the external oblique intercostal (EOI) block, can be used as part of multimodal analgesia for upper abdominal surgeries. The aim of our study is to investigate the effectiveness of EOI block in patients undergoing LSG. MATERIALS AND METHODS Sixty patients were assigned into two groups either EOI or port-site infiltration (PSI). The EOI group received ultrasound-guided 30 ml 0.25% bupivacaine, while the PSI group received 5 ml of 0.25% bupivacaine at each port sites by the surgeon. Data on clinical and demographic were collected and analyzed. RESULTS There were no statistical differences in terms of demographic details (p > 0.05). VAS scores were statistically lower during resting at PACU, 1, 2, 4, 8, and 12 h postoperatively in the EOI group than PSI group (p < 0.05), The VAS scores were also lower during active movement at PACU, 1, 2, 4, and 8 h postoperatively in the EOI group than PSI group (p < 0.05). Twenty-four-hour fentanyl consumption was lower in the EOI than in the PSI group (505.83 ± 178.56 vs. 880.83 ± 256.78 μg, respectively, p < 0.001). Rescue analgesia was higher in PSI group than EOI group (26/30 vs. 14/30, respectively, p = 0.001). CONCLUSION EOI block can be used as a part of multimodal analgesia due to its simplicity and effective postoperative analgesia in LSG.
Collapse
Affiliation(s)
- Omer Doymus
- Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.
- Clinical Research, Development and Design Application and Research Center, Ataturk University School of Medicine, 25240, Erzurum, Turkey.
| | - Ahmet Kaciroglu
- Department of Anaesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkey
| | - Zehra Bedir
- Department of Anaesthesiology and Reanimation, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Serkan Tayar
- Department of General Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mustafa Yeni
- Department of General Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Erdem Karadeniz
- Department of General Surgery, Ataturk University School of Medicine, Erzurum, Turkey
| |
Collapse
|
18
|
Schiessler J, Leffler A. [Opioid-free anesthesia : Wrong track or meaningful exit from the era of opioid-based analgesia?]. DIE ANAESTHESIOLOGIE 2024; 73:223-231. [PMID: 38568253 DOI: 10.1007/s00101-024-01397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
The limitations and disadvantages of opioids in anesthesia are very well known but the advantages combined with a lack of effective alternatives even now still prevents refraining from using opioids as part of an adequate pain therapy. For decades, pain research has had the declared goal of replacing opioids with new substances which have no serious side effects; however, currently this goal seems to be a long way off. Due to the media coverage of the "opioid crisis" in North America, the use of opioids for pain management is also increasingly being questioned by the patients. Measures to contain this crisis are only slowly taking effect in view of the increasing number of deaths, which is why the triggers are still being sought. The perioperative administration of opioids is not only a possible gateway to addiction and abuse but it can also cause outcome-relevant complications, such as respiratory depression, postoperative nausea and vomiting and an increase in postoperative pain. Therefore, these considerations gave rise to the idea of an opioid-free anesthesia (OFA), i.e., opioids are not administered as part of anesthesia to carry out surgical procedures. Although this idea may make sense at first glance, a rapid introduction of this concept appears to be risky as it entails significant changes for the entire anesthesiological management. Based on relatively robust data from clinical studies, this concept can now be evaluated and discussed not only emotionally but also objectively. This review article presents arguments for or against the complete avoidance of intraoperative or even perioperative opioids. The current conditions in Germany are primarily taken into account, so that the perioperative pain therapy is transferable to the established standards. The results from current clinical studies on the implementation of an opioid-free anesthesia are summarized and discussed.
Collapse
Affiliation(s)
- Julia Schiessler
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Andreas Leffler
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| |
Collapse
|
19
|
Clanet M, Touihri K, El Haddad C, Goldsztejn N, Himpens J, Fils JF, Gricourt Y, Van der Linden P, Coeckelenbergh S, Joosten A, Dandrifosse AC. Effect of opioid-free versus opioid-based strategies during multimodal anaesthesia on postoperative morphine consumption after bariatric surgery: a randomised double-blind clinical trial. BJA OPEN 2024; 9:100263. [PMID: 38435809 PMCID: PMC10906147 DOI: 10.1016/j.bjao.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Background The efficacy and safety of opioid-free anaesthesia during bariatric surgery remain debated, particularly when administering multimodal analgesia. As multimodal analgesia has become the standard of care in many centres, we aimed to determine if such a strategy coupled with either dexmedetomidine (opioid-free anaesthesia) or remifentanil with a morphine transition (opioid-based anaesthesia), would reduce postoperative morphine requirements and opioid-related adverse events. Methods In this prospective double-blind study, 172 class III obese patients having laparoscopic gastric bypass surgery were randomly allocated to receive either sevoflurane-dexmedetomidine anaesthesia with a continuous infusion of lidocaine and ketamine (opioid-free group) or sevoflurane-remifentanil anaesthesia with a morphine transition (opioid-based group). Both groups received at anaesthesia induction a bolus of magnesium, lidocaine, ketamine, paracetamol, diclofenac, and dexamethasone. The primary outcome was 24-h postoperative morphine consumption. Secondary outcomes included postoperative quality of recovery (QoR40), incidence of hypoxaemia, bradycardia, and postoperative nausea and vomiting (PONV). Results Eighty-six patients were recruited in each group (predominantly women, 70% had obstructive sleep apnoea). There was no significant difference in postoperative morphine consumption (median [inter-quartile range]: 16 [13-26] vs 15 [10-24] mg, P=0.183). The QoR40 up to postoperative day 30 did not differ between groups, but PONV was less frequent in the opioid-free group (37% vs 59%, P=0.005). Hypoxaemia and bradycardia were not different between groups. Conclusions During bariatric surgery, a multimodal opioid-free anaesthesia technique did not decrease postoperative morphine consumption when compared with a multimodal opioid-based strategy. Quality of recovery did not differ between groups although the incidence of PONV was less in the opioid-free group. Clinical trial registration NCT05004519.
Collapse
Affiliation(s)
- Matthieu Clanet
- Department of Anaesthesiology, Chirec Delta Hospital, Brussels, Belgium
| | - Karim Touihri
- Department of Anaesthesiology, Chirec Delta Hospital, Brussels, Belgium
| | - Celine El Haddad
- Department of Anaesthesiology, Chirec Delta Hospital, Brussels, Belgium
| | | | - Jacques Himpens
- Department of General Surgery, Chirec Delta Hospital, Brussels, Belgium
| | | | - Yann Gricourt
- Department of Anaesthesiology, Nimes University Hospital, Nimes, France
| | | | - Sean Coeckelenbergh
- Department of Anaesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Alexandre Joosten
- Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, LA, CA, USA
| | | |
Collapse
|
20
|
Dai J, Li S, Weng Q, Long J, Wu D. Opioid-free anesthesia with ultrasound-guided quadratus lumborum block in the supine position for lower abdominal or pelvic surgery: a randomized controlled trial. Sci Rep 2024; 14:4652. [PMID: 38409359 PMCID: PMC10897418 DOI: 10.1038/s41598-024-55370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
In the past, quadratus lumborum block (QLB) was mostly used for postoperative analgesia in patients, and few anesthesiologists applied it during surgery with opioid-free anesthesia (OFA). Consequently, it is still unclear whether QLB in the supine position can provide perfect analgesia and inhibit anesthetic stress during surgery under the OFA strategy. To observe the clinical efficacy of ultrasound-guided quadratus lumborum block (US-QLB) in the supine position with OFA for lower abdominal and pelvic surgery. A total of 122 patients who underwent lower abdominal or pelvic surgery in People's Hospital of Wanning between March 2021 and July 2022 were selected and divided into a quadratus lumborum block group (Q) (n = 62) and control group (C) (n = 60) according to the random number table method. Both groups underwent general anesthesia combined with QLB in the supine position. After sedation, unilateral or bilateral QLB was performed via the ultrasound guided anterior approach based on images resembling a "human eye" and "baby in a cradle" under local anesthesia according to the needs of the operative field. In group Q, 20 ml of 0.50% lidocaine and 0.20% ropivacaine diluted in normal saline (NS) were injected into each side. In group C, 20 ml of NS was injected into each side. The values of BP, HR, SPO2, SE, RE, SPI, NRS, Steward score, dosage of propofol, dexmedetomidine, and rocuronium, the number of patients who needed remifentanil, propofol, or diltiazem, puncture point, block plane, duration of anesthesia, catheter extraction, and wakefulness during the operation were monitored. There were no significant differences in the general data, number of cases requiring additional remifentanil, propofol, or diltiazem treatment, as well as puncture point and puncture plane between the two groups (P > 0.05). HR, SBP, and DBP values were higher in group Q than in group C at T1; HR, SPI, and SE, while RE values were lower in group Q than in group C at T3, SE, and RE; the Steward score was higher in group Q than in group C at T4 and T5, and the difference was statistically significant (P < 0.05). The extubation and awake times were lower in group Q than in group C, and the difference was statistically significant (P < 0.05). The SE, RE, and SPI values were lower at T1, T2, T3, and T4 than at T0. The Steward scores at T4 and T5 were higher in group Q than in group C, and were lower than at T0, with a statistically significant difference (P < 0.05). There were significant differences in the effectiveness of postoperative analgesia between the two groups at t1, t3 and t4 (P < 0.05). US-QLB in the supine position with OFA is effective in patients undergoing lower abdominal or pelvic surgery with stable intraoperative vital signs, complete recovery and better postoperative analgesia.
Collapse
Affiliation(s)
- Jingwei Dai
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Shanliang Li
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Qijun Weng
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Jinxiong Long
- Department of Anesthesiology, People's Hospital of Wanning, Wanning, 571500, Hainan, China
| | - Duozhi Wu
- Department of Anesthesiology, Hainan General Hospital, Haikou, 570311, Hainan, China.
| |
Collapse
|
21
|
Stasiowski MJ, Lyssek-Boroń A, Kawka-Osuch M, Niewiadomska E, Grabarek BO. Possibility of Using Surgical Pleth Index in Predicting Postoperative Pain in Patients after Vitrectomy Performed under General Anesthesia. Diagnostics (Basel) 2024; 14:425. [PMID: 38396464 PMCID: PMC10887804 DOI: 10.3390/diagnostics14040425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Adequacy of anesthesia concept (AoA) in the guidance of general anesthesia (GA) is based on entropy, and it also reflects the actual depth of anesthesia and the surgical pleth index (SPI). Therefore, this study aimed to analyze the potential existence of relationships between SPI values at certain stages of the AoA-guided GA for vitreoretinal surgeries (VRS) and the incidence of intolerable postoperative pain perception (IPPP). A total of 175 patients were each assigned to one of five groups. In the first, the VRS procedure was performed under GA without premedication; in the second group, patients received metamizole before GA; in the third, patients received acetaminophen before GA; in the fourth group, patients received Alcaine before GA; and, in the peribulbar block group, the patients received a peribulbar block with a mix of the solutions of lignocaine and bupivacaine. Between the patients declaring mild and statistically significant differences in the IPPP in terms of SPI values before induction (52.3 ± 18.8 vs. 63.9 ± 18.1, p < 0.05) and after emergence from GA (51.1 ± 13 vs. 68.1 ± 8.8; p < 0.001), it was observed that the patients postoperatively correlated with heart rate variations despite the group allocation. The current study proves the feasibility that preoperative SPI values help with predicting IPPP immediately after VRS under AoA guidance and discrimination (between mild diagnoses and IPPP when based on postoperative SPI values) as they correlate with heart rate variations. Specifically, this applies when the countermeasures of IPPP and hemodynamic fluctuations are understood to be of importance in reducing unwelcome adverse events.
Collapse
Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Division of Medical Sciences in Zabrze, Medical University of Silesia, 40-555 Katowice, Poland
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.-O.)
- Department of Ophthalmology, Faculty of Medicine in Zabrze, Academy of Silesia, 40-555 Katowice, Poland
| | - Magdalena Kawka-Osuch
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.-O.)
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-555 Katowice, Poland;
| | | |
Collapse
|
22
|
Liu Z, Bi C, Li X, Song R. The efficacy and safety of opioid-free anesthesia combined with ultrasound-guided intermediate cervical plexus block vs. opioid-based anesthesia in thyroid surgery-a randomized controlled trial. J Anesth 2023; 37:914-922. [PMID: 37740124 PMCID: PMC10654206 DOI: 10.1007/s00540-023-03254-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE In the context of the current comfort medicine and enhanced recovery after surgery, there is a demand for a new anesthesia method to reduce adverse reactions and accelerate recovery after surgery. This randomized controlled trial aimed to compare the efficacy and safety between opioid-free anesthesia (OFA) combined with ultrasound-guided intermediate cervical plexus block (ICPB) and opioid-based anesthesia in patients after thyroid surgery. METHODS In this study, 75 patients scheduled for thyroid surgery under general anesthesia were randomly allocated into two groups. The primary outcome included the incidence of nausea within 24 h after surgery. The main secondary outcomes included the incidence of vomiting and the visual analog score (VAS) scores within 24 h after surgery as well as the quality of recovery 40 questionnaires (QoR-40) scores 24 h after surgery. RESULTS In the OFA group, the incidence of postoperative nausea was 6.1%, compared to 39.4% in the control group (p = 0.001). No patient presented with postoperative vomiting in the OFA group, while 15.2% of patients suffered from postoperative vomiting in the control group (p = 0.063). The VAS scores of patients in the postanesthetic care unit (PACU) and 2 h, 4 h, and 6 h after surgery were lower in the OFA group, and the difference is statistically significant. Besides, the VAS scores of patients at rest (p = 1.000) and during swallowing (p = 1.000) 24 h after surgery were comparable. CONCLUSION Compared with opioid-based anesthesia, the OFA combined with the ultrasound-guided ICPB can better improve patients' postoperative recovery, reduce nausea, and decrease pain scores. TRIAL REGISTRATION Chinese Clinical Trial Regisrty, ChiCTR2200056344, https://www.chictr.org.cn.
Collapse
Affiliation(s)
- Zhi Liu
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
- China Medical University, Shenyang, China
| | - Congjie Bi
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China.
| | - Xingguo Li
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Ruonan Song
- Department of Anesthesiology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| |
Collapse
|
23
|
Zhang Y, Ma D, Lang B, Zang C, Sun Z, Ren S, Chen H. Effect of opioid-free anesthesia on the incidence of postoperative nausea and vomiting: A meta-analysis of randomized controlled studies. Medicine (Baltimore) 2023; 102:e35126. [PMID: 37746991 PMCID: PMC10519493 DOI: 10.1097/md.0000000000035126] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Research on opioid-free anesthesia has increased in recent years; however, it has never been determined whether it is more beneficial than opioid anesthesia. This meta-analysis was primarily used to assess the effect of opioid-free anesthesia compared with opioid anesthesia on the incidence of postoperative nausea and vomiting. METHODS We searched the electronic databases of PubMed, the Cochrane Library, Web of Science and Embase from 2014 to 2022 to identify relevant articles and extract relevant data. The incidence of postoperative nausea and vomiting, time to extubation, pain score at 24 hours postoperatively, and time to first postoperative rescue analgesia were compared between patients receiving opioid-free anesthesia and those receiving standard opioid anesthesia. Differences in the incidence of postoperative nausea and vomiting were evaluated using risk ratios (95% confidence interval [CI]). The significance of the differences was assessed using mean differences and 95% CI. The heterogeneity of the subject trials was evaluated using the I2 test. Statistical analysis was performed using the RevMan 5.4 software. RESULTS Fourteen randomized controlled trials, including 1354 participants, were evaluated in the meta-analysis. As seen in the forest plot, the OFA group had a lower risk of postoperative nausea and vomiting than the control group (risk ratios = 0.41, 95% CI: 0.33-0.51, P < .00001; n = 1354), and the meta-analysis also found that the OFA group had lower postoperative analgesia scores at 24 hours (P < .000001), but time to extubation (P = .14) and first postoperative resuscitation analgesia time (P < .54) were not significantly different. CONCLUSIONS Opioid-free anesthesia reduces the incidence of postoperative nausea and vomiting while providing adequate analgesia without interfering with postoperative awakening.
Collapse
Affiliation(s)
- Yanan Zhang
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Dandan Ma
- Department of Anesthesiology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| | - Bao Lang
- Department of Anesthesiology, Weifang People’s Hospital, Weifang, China
| | - Chuanbo Zang
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Zenggang Sun
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Shengjie Ren
- School of Anesthesiology, Weifang Medical University, Weifang, China
| | - Huayong Chen
- Department of Anesthesiology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China
| |
Collapse
|
24
|
Mieszczański P, Górniewski G, Ziemiański P, Cylke R, Lisik W, Trzebicki J. Comparison between multimodal and intraoperative opioid free anesthesia for laparoscopic sleeve gastrectomy: a prospective, randomized study. Sci Rep 2023; 13:12677. [PMID: 37542100 PMCID: PMC10403571 DOI: 10.1038/s41598-023-39856-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023] Open
Abstract
Anesthesia for laparoscopic sleeve gastrectomy and perioperative management remains a challenge. Several clinical studies indicate that opioid-free anesthesia (OFA) may be beneficial, but there is no consensus on the most optimal anesthesia technique in clinical practice. The aim of our study was to assess the potential benefits and risks of intraoperative OFA compared to multimodal analgesia (MMA) with remifentanil infusion. In a prospective, randomized study, we analyzed 59 patients' data. Primary outcome measures were oxycodone consumption and reported pain scores (numerical rating scale, NRS) at 1, 6, 12, and 24th hours after surgery. Postoperative sedation on the Ramsay scale, nausea and vomiting on the PONV impact scale, desaturation episodes, pruritus, hemodynamic parameters, and hospital stay duration were also documented and compared. There were no significant differences in NRS scores or total 24-h oxycodone requirements. In the first postoperative hour, OFA group patients needed an average of 4.6 mg of oxycodone while the MMA group 7.72 mg (p = 0.008, p < 0.05 statistically significant). The PONV impact scale was significantly lower in the OFA group only in the first hour after the operation (p = 0.006). Patients in the OFA group required higher doses of ephedrine 23.67 versus 15.69 mg (p = 0.039) and more intravenous fluids 1160 versus 925.86 ml (p = 0.007). The mode of anesthesia did not affect the pain scores or the total dose of oxycodone in the first 24 postoperative hours. Only in the first postoperative hour were an opioid-sparing effect and reduction of PONV incidence seen in the OFA group when compared with remifentanil-based anesthesia. However, patients in the OFA group showed significantly greater hemodynamic lability necessitating higher vasopressor doses and more fluid volume.
Collapse
Affiliation(s)
- Piotr Mieszczański
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warszawa, Poland.
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland.
| | - Grzegorz Górniewski
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warszawa, Poland
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland
| | - Paweł Ziemiański
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warszawa, Poland
| | - Radosław Cylke
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warszawa, Poland
| | - Wojciech Lisik
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warszawa, Poland
| | - Janusz Trzebicki
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warszawa, Poland
- Szpital Kliniczny Dzieciątka Jezus, ul. Lindleya 4, 02-005, Warszawa, Poland
| |
Collapse
|
25
|
Kleipool SC, van Rutte PWJ, Eeftinck Schattenkerk LD, Bonjer HJ, Marsman HA, de Castro SMM, van Veen RN. Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge. Obes Surg 2023; 33:2317-2323. [PMID: 37347399 DOI: 10.1007/s11695-023-06697-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. METHODS A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. RESULTS In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. CONCLUSION A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.
Collapse
Affiliation(s)
| | | | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
| |
Collapse
|
26
|
Ulbing S, Infanger L, Fleischmann E, Prager G, Hamp T. The Performance of Opioid-Free Anesthesia for Bariatric Surgery in Clinical Practice. Obes Surg 2023:10.1007/s11695-023-06584-5. [PMID: 37106268 DOI: 10.1007/s11695-023-06584-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
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.
Collapse
Affiliation(s)
- Stefan Ulbing
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Lukas Infanger
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Edith Fleischmann
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
27
|
Nayak SS, Magoon R. Opioid-free anesthesia for the obese: An evolving script…. Saudi J Anaesth 2023; 17:286. [PMID: 37260642 PMCID: PMC10228861 DOI: 10.4103/sja.sja_568_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/07/2022] [Indexed: 03/11/2023] Open
Affiliation(s)
- Sudhansu Sekhar Nayak
- Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| | - Rohan Magoon
- Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
| |
Collapse
|
28
|
Efficacy and Safety of Parenteral Injection of an Extended Release κ-receptor Opioid Sebacoyl Dinalbuphine Ester for Acute and Chronic Pain After Laparoscopic Bariatric Surgery: a Randomized, Placebo-Controlled, Double-Blind Trial. Obes Surg 2023; 33:1192-1201. [PMID: 36787017 DOI: 10.1007/s11695-023-06502-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/29/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE μ-receptor opioids are associated with unwanted gastrointestinal side effects and respiratory depression. A long-acting non-μ-receptor parenteral opioid is not currently available for management of acute and chronic postsurgical pain (CPSP). This double-blind clinical trial tested an extended-release κ-receptor agonist, sebacoyl dinalbuphine ester (SDE, Naldebain®) for management of surgical pain after laparoscopic bariatric surgery. MATERIALS AND METHODS Patients were randomly assigned to receive a single intramuscular injection of SDE (150 mg, n = 30) or vehicle solution (n = 30) at > 12 h before surgery. All patients received standard perioperative multimodal analgesia (MMA). The primary endpoint was the pain intensity in the beginning 7 days after operation. The secondary endpoints were adverse reactions up to 7 days and incidence of CPSP at 3 months after surgery. RESULTS Compared with placebos, the area under curves of visual analog scale (VAS) for 0-48 h after operation were significantly reduced in SDE group (143.3 ± 65.4 and 105.9 ± 36.3, P = 0.025). There were significantly fewer patients in the SDE group who had moderate-to-severe pain (VAS ≥ 4) (16.7% vs 50%; P = 0.012) at postoperative 48 h. Pain intensities were similar between the two groups at 72 h and 7 days postoperatively. The incidence of CPSP at 3 months was not different. SDE did not increase drug-related systemic adverse events. CONCLUSION In addition to the standard perioperative MMA, a single-dose injection of long-acting κ-receptor agonist SDE provides significantly better pain management for 48 h following laparoscopic bariatric surgery. A long-acting κ-receptor agonist opioid could improve in-hospital pain management and potentiate early discharge after operation without increasing drug-related systemic complications.
Collapse
|
29
|
Guo Y, Chen L, Gao Z, Zhang M, Liu M, Gao X, Liu Y, Zhang X, Guo N, Sun Y, Wang Y. Is esketamine-based opioid-free anesthesia more superior for postoperative analgesia in obstructive sleep apnea patients undergoing bariatric surgery? A study protocol. Front Med (Lausanne) 2022; 9:1039042. [PMID: 36457567 PMCID: PMC9705763 DOI: 10.3389/fmed.2022.1039042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/27/2022] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Opioid-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 ANALYSIS This 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. DISCUSSION The 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 DISSEMINATION This 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 [NCT05386979].
Collapse
Affiliation(s)
- Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Zhongquan Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Na Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| |
Collapse
|