Effect of Opioid-Free Versus Opioid Anesthesia on the Quality of Postoperative Recovery in Patients Receiving Laparoscopic Sleeve Gastrectomy

Abstract

Background: Opioids are commonly used in general anesthesia for pain management. However, they are related to obvious side effects. Patients with obesity undergoing laparoscopic sleeve gastrectomy are at higher risk of experiencing adverse effects associated with opioids. However, there is great heterogeneity in how to select and combine antinociceptive drugs to replace opioids. This randomized controlled double-blind study was conducted to evaluate the use effect of opioid-free anesthesia (OFA) in obese patients undergoing laparoscopic sleeve gastrectomy on the quality of postoperative recovery.

Methods: This prospective, parallel-group, double-blind, randomized controlled study included seventy-six patients undergoing laparoscopic sleeve gastrectomy in Beijing Friendship Hospital, Capital Medical University. Patients were randomly assigned to OFA group or opioid-based anesthesia (OBA) group. The primary outcome included the 15-item recovery quality scale (QOR-15). Secondary measures included intraoperative hemodynamic stability, intraoperative operation information, duration of until postoperative PACU Aldrete score > 9 points, anesthesia-related complication, and number of analgesic pump presses.

Results: The scores of QOR-15 in OFA group were higher than that in OBA group at 24 h and 48 h after surgery. The total dose of propofol required in OFA group was statistically less than that in OBA group. Patients in the OBA group had significantly lower bispectral index (BIS) values and lower levels of MAP at T2 (after intubation) than those in the OFA group patients in the OBA group. Patients in the OFA group showed significantly lower levels of heart rate (HR) at T3 (after abdominal closure) when compared to the OBA group. The changing trend of visual analog scale (VAS) and OBAS scores recorded after surgery were similar between both groups and the VAS and Overall Benefit of Analgesia Scale (OBAS) scores in OBA group were obviously higher than those in OFA group in each time point. The Rhodes Index of Nausea and Vomiting in OBA group were obviously higher than those in OFA group in each time point.

Conclusions: OFA significantly improved postoperative recovery quality as evidenced by higher QOR-15 scores, reduced postoperative nausea and vomiting (PONV), lower pain scores and decreased opioid requirements compared to OBA. Although duration of awakening from anesthesia was prolonged, OFA demonstrated superior recovery outcomes and fewer complications supporting its clinical utility in obese patients undergoing laparoscopic sleeve gastrectomy.

Keywords: Laparoscopic sleeve gastrectomy; Obesity; Opioid-based anesthesia; Opioid-free anesthesia; Postoperative recovery.

Fig. 1

Flow diagram showing the patients that were included and excluded in this study

Fig. 2

Comparison of intraoperative measurements between two groups. Mean arterial pressure (MAP); Heart rate (HR); Bispectral index (BIS). After entering the operation room (T1); after intubating (T2); after closing abdomen (T3). *; p <0.05 when comapred to the pre-time point. #: p <0.05 when comapred to the OFA group

Fig. 3

a The comparison of Global score Quality of Recovery-15 scale (QOR-15) before surgery and 6, 24, and 48 h after surgery between the two groups. b Visual analog scale (VAS) score at different times after surgery. c The comparison of Rhodes Index of Nausea and Vomiting before surgery and 6, 24, and 48 h after surgery between the two groups. *P < 0.001 OFA vs OBA group at the same time point