Less Opioid Consumption Reported With Opioid-Free Anesthesia for Bariatric Surgery

An opioid-free anesthesia strategy among patients undergoing bariatric surgery for weight loss was associated with decreased morphine consumption in the 24 hours after surgery compared with opioid-balanced anesthesia.

A retrospective cohort study found opioid-free anesthesia (OFA) to be associated with lower morphine requirements than opioid-balanced anesthesia (OBA) among patients undergoing laparoscopic bariatric surgery for weight loss. These findings were published in the Journal of Clinical Anesthesia.

Patients (N=257) undergoing laparoscopic bariatric surgery at Edouard Herriot hospital in France between 2017 and 2019 were included in this study. At the study site, anesthesia strategies changed over time. In December 2017, the use of intraoperative opioids was discontinued. Between December 2017 and September 2018, patients received clonidine. Between September 2018 and March 2019, patients received dexmedetomidine. Opioid consumption and pain outcomes were evaluated among patients who received OBA (n=77), OFA with clonidine (OFAC; n=90), or OFA with dexmedetomidine (OFAD; n=90).

Women made up 64%, 71%, and 71% of the OBA, OFAC, and OFAD cohorts, respectively; BMI was 43, 42, and 43 kg/m2; 58%, 47%, and 51% underwent gastric bypass, respectively; 42%, 53%, and 49% underwent gastric sleeve procedures, respectively; and the median length of surgery was 125, 114, and 106 minutes, respectively.

During surgery, more patients in the OBA cohort received desflurane (90% vs 52% vs 23%; P =.001), and fewer patients received propofol (3% vs 43% vs 73%; P <.001) compared with the OFAC and OFAD cohorts, respectively.

In obese patients undergoing bariatric surgery, OFA was safely associated with a reduction in morphine consumption during the first 24 postoperative hours as compared to OBA.

During the first 24 hours after surgery, more patients in the pooled OFA cohort did not receive opioids compared with patients in the OBA group (adjusted odds ratio [aOR], 7.99; 95% CI, 4.05-16.48; P <.001). Within the pooled OFA cohort, more recipients of dexmedetomidine did not receive morphine compared with those receiving clonidine (93% vs 81%; P =.026).

The average dose of opioids in the first 24 hours after surgery was 2±3 mg for patients receiving OBA, 1±3 mg for patients receiving OFAC, and 1±4 mg for patients receiving OFAD (P <.001).

Fewer study participants in the pooled OFA cohort required antiemetic rescue compared with participants in the OBA group (aOR, 0.1; 95% CI, 0.02-0.41; P <.001).

In the postanesthesia care unit, OFA was found to be associated with decreased highest visual analogue scale score for pain compared with OBA (median, 1 vs 3; P <.001, respectively).

Major limitations of this study include the lack of postoperative respiratory data and its retrospective design.

Researchers concluded, “In obese patients undergoing bariatric surgery, OFA was safely associated with a reduction in morphine consumption during the first 24 postoperative hours as compared to OBA.” They also reported lower pain scores in the recovery room compared with OBA. These data indicated that avoiding anesthesia with opioids is feasible in the setting of bariatric surgery.

This article originally appeared on Clinical Pain Advisor

References:

Berlier J, Carabalona J-F, Tête H. Effects of opioid-free anesthesia on postoperative morphine consumption after bariatric surgery. J Clin Anesth. Published online June 15, 2022. doi:10.1016/j.jclinane.2022.110906