Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial
Abstract Background Opioids are commonly used in general anesthesia for pain management. However, they are linked to significant side effects. Patients undergoing laparoscopic sleeve gastrectomy, particularly those with obesity, are at higher risk of experiencing adverse effects associated with opio...
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BMC
2025-02-01
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| Series: | Perioperative Medicine |
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| Online Access: | https://doi.org/10.1186/s13741-024-00486-5 |
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| author | Hanane Barakat Linda Gholmieh Jessy Abou Nader Vanda Yazbeck Karam Obey Albaini Mohamad El Helou Rony Al Nawwar |
| author_facet | Hanane Barakat Linda Gholmieh Jessy Abou Nader Vanda Yazbeck Karam Obey Albaini Mohamad El Helou Rony Al Nawwar |
| author_sort | Hanane Barakat |
| collection | DOAJ |
| description | Abstract Background Opioids are commonly used in general anesthesia for pain management. However, they are linked to significant side effects. Patients undergoing laparoscopic sleeve gastrectomy, particularly those with obesity, are at higher risk of experiencing adverse effects associated with opioids. Therefore, there is a need to explore alternative anesthesia options that do not rely on opioids. This study aims to investigate the efficacy of opioid-free anesthesia (OFA) compared to traditional opioid-based anesthesia (OBA) in patients undergoing laparoscopic sleeve gastrectomy. Methods This single-center randomized controlled trial included eighty-three patients undergoing laparoscopic sleeve gastrectomy in a tertiary hospital. Patients were randomly assigned to dexmedetomidine and lidocaine infusion (OFA) or remifentanil (OBA). All patients received intra-operative propofol, sevoflurane, a neuromuscular blocking agent, and ketamine. The primary outcome included opioid consumption during the post-anesthesia care unit (PACU). Secondary measures included intraoperative hemodynamic stability, time to extubation, PACU stay duration, opioid consumption during the first 48 h, and anti-emetic requirements. Independent samples t-test or Mann–Whitney U test was used to assess for differences across the two groups. Results PACU morphine consumption, total postoperative morphine consumption, anti-emetic requirements up to 48 h after surgery, and pain levels after surgery were not statistically significantly different between OFA and OBA groups. Other variables were not statistically different between the two groups, except for intraoperative anti-hypertensives where more patients in the OFA groups required it. Conclusions Opioid-free anesthesia hasn’t shown an opioid-sparing effect in patients with obesity undergoing laparoscopic sleeve gastrectomy. Larger multi-center studies are required to fully establish its effectiveness. Trial registration ClinicalTrials.gov (NCT03507634); first trial registration date: 12/04/2018; first posted date: 25/04/2018. |
| format | Article |
| id | doaj-art-8f86dc64f251423bb403805503be2222 |
| institution | Kabale University |
| issn | 2047-0525 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj-art-8f86dc64f251423bb403805503be22222025-02-09T12:47:54ZengBMCPerioperative Medicine2047-05252025-02-011411810.1186/s13741-024-00486-5Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trialHanane Barakat0Linda Gholmieh1Jessy Abou Nader2Vanda Yazbeck Karam3Obey Albaini4Mohamad El Helou5Rony Al Nawwar6Department of Anesthesiology, Lebanese American University Medical Center Rizk HospitalDepartment of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical CenterDepartment of Anesthesiology and Perioperative Medicine, Saint Joseph HospitalDepartment of Anesthesiology, Lebanese American University Medical Center Rizk HospitalSchool of Population and Global Health, Faculty of Medicine, McGill UniversityDepartments of Medicine and Health Sciences, American University of BeirutDepartment of Anesthesiology, Lebanese American University Medical Center Rizk HospitalAbstract Background Opioids are commonly used in general anesthesia for pain management. However, they are linked to significant side effects. Patients undergoing laparoscopic sleeve gastrectomy, particularly those with obesity, are at higher risk of experiencing adverse effects associated with opioids. Therefore, there is a need to explore alternative anesthesia options that do not rely on opioids. This study aims to investigate the efficacy of opioid-free anesthesia (OFA) compared to traditional opioid-based anesthesia (OBA) in patients undergoing laparoscopic sleeve gastrectomy. Methods This single-center randomized controlled trial included eighty-three patients undergoing laparoscopic sleeve gastrectomy in a tertiary hospital. Patients were randomly assigned to dexmedetomidine and lidocaine infusion (OFA) or remifentanil (OBA). All patients received intra-operative propofol, sevoflurane, a neuromuscular blocking agent, and ketamine. The primary outcome included opioid consumption during the post-anesthesia care unit (PACU). Secondary measures included intraoperative hemodynamic stability, time to extubation, PACU stay duration, opioid consumption during the first 48 h, and anti-emetic requirements. Independent samples t-test or Mann–Whitney U test was used to assess for differences across the two groups. Results PACU morphine consumption, total postoperative morphine consumption, anti-emetic requirements up to 48 h after surgery, and pain levels after surgery were not statistically significantly different between OFA and OBA groups. Other variables were not statistically different between the two groups, except for intraoperative anti-hypertensives where more patients in the OFA groups required it. Conclusions Opioid-free anesthesia hasn’t shown an opioid-sparing effect in patients with obesity undergoing laparoscopic sleeve gastrectomy. Larger multi-center studies are required to fully establish its effectiveness. Trial registration ClinicalTrials.gov (NCT03507634); first trial registration date: 12/04/2018; first posted date: 25/04/2018.https://doi.org/10.1186/s13741-024-00486-5Bariatric surgerySleeve gastrectomyOpioid-free anesthesiaPostoperative painOpioid |
| spellingShingle | Hanane Barakat Linda Gholmieh Jessy Abou Nader Vanda Yazbeck Karam Obey Albaini Mohamad El Helou Rony Al Nawwar Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial Perioperative Medicine Bariatric surgery Sleeve gastrectomy Opioid-free anesthesia Postoperative pain Opioid |
| title | Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial |
| title_full | Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial |
| title_fullStr | Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial |
| title_full_unstemmed | Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial |
| title_short | Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial |
| title_sort | opioid free versus opioid based anesthesia in laparoscopic sleeve gastrectomy a single center randomized controlled trial |
| topic | Bariatric surgery Sleeve gastrectomy Opioid-free anesthesia Postoperative pain Opioid |
| url | https://doi.org/10.1186/s13741-024-00486-5 |
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