Low opioid anesthesia and opioid free anesthesia use in pain control treatment in postoperative period

Postoperative pain is a complex and multifactorial symptom that requires a well thought approach using different treatments to achieve the optimal outcome after surgery. Contemporary anaesthesiology, looking for an alternative to analgesia with the use of opioids, more often turns to the protocols of low-opioid and opioid free treatment and pain control. By replacing opioids with non-opioid analgesics, koanalgetics, as well as using local and regional anesthetic techniques, we limit or avoid adverse effects of opioids while maintaining a satisfactory level of analgesia for the patient. Methods of general anesthesia without or with the minimum amount of opioid drugs are of particular importance in bariatric surgery due to a reduction in the incidence of post-operative respiratory depression and excessive sedation. They also allow to achieve and maintain cardiovascular stability in the intraoperative and postoperative period, prevent the occurrence of opioid-induced hyperalgesia (the so-called opioid paradox), and improve the comfort of patients in the post-operative period due to the lower incidence of post-operative nausea and vomiting and constipation. The particular significance of regional and local analgesia techniques, which supplement general anesthesia and reduce the need for analgesics in the perioperative period, is emphasized. This analysis presents the theoretical foundations of multimodal analgesia and existing scientific evidence confirming its benefits in improving pain control after surgery.