Opioid-free versus opioid-based anesthesia in laparoscopic sleeve gastrectomy: a single-center, randomized, controlled trial.

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.