Skip to main content
SpringerLink
Log in

Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies

  • Review
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

This meta-analysis aimed at exploring the impact of opioid-free anesthesia (OFA) on pain score and opioid consumption in patients undergoing bariatric surgery (BS). Literature search identified eight eligible trials. Forest plot revealed a significantly lower pain score (mean difference (MD) =  − 0.96, p = 0.0002; 318 patients), but not morphine consumption (MD =  − 5.85 mg, p = 0.1; 318 patients) at postoperative 24 h in patients with OFA than in those without. Pooled analysis also showed a lower pain score (p = 0.002), morphine consumption (p = 0.0003) in the postanesthetic care unit, and risk of postoperative nausea/vomiting (p = 0.0003) in the OFA group compared to the controls. In conclusion, this meta-analysis demonstrated that opioid-free anesthesia improved pain outcomes immediately and at 24 h after surgery without a beneficial impact on opioid consumption at postoperative 24 h.

Key points

• Roles of opioid-free anesthesia (OFA) in bariatric surgery (BS) were investigated.

• Outcomes included postoperative pain score, opioid use, and nausea/vomiting risk.

• OFA was associated with lower 24-h pain score but not opioid consumption.

• Lower pain score and opioid consumption were noted in the postanesthetic care unit.

• OFA correlated with a lower risk of postoperative nausea/vomiting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  2. Nguyen NT, Goldman CD, Ho HS, Gosselin RC, Singh A, Wolfe BM. Systemic stress response after laparoscopic and open gastric bypass. J Am Coll Surg. 2002;194:557–66; discussion 66–7.

  3. Shinoda T, Murakami W, Takamichi Y, Iizuka H, Tanaka M, Kuwasako Y. Effect of remifentanil infusion rate on stress response in orthopedic surgery using a tourniquet application. BMC Anesthesiol. 2013;13:14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Demirbilek S, Ganidağli S, Aksoy N, Becerik C, Baysal Z. The effects of remifentanil and alfentanil-based total intravenous anesthesia (TIVA) on the endocrine response to abdominal hysterectomy. J Clin Anesth. 2004;16:358–63.

    Article  CAS  PubMed  Google Scholar 

  5. Gesztesi Z, Mootz BL, White PF. The use of a remifentanil infusion for hemodynamic control during intracranial surgery. Anesth Analg. 1999;89:1282–7.

    Article  CAS  PubMed  Google Scholar 

  6. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112:991–1004.

    Article  CAS  PubMed  Google Scholar 

  7. Montandon G, Horner RL. Electrocortical changes associating sedation and respiratory depression by the opioid analgesic fentanyl. Sci Rep. 2019;9:14122.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Hozumi J, Egi M, Sugita S, Sato T. Dose of intraoperative remifentanil administration is independently associated with increase in the risk of postoperative nausea and vomiting in elective mastectomy under general anesthesia. J Clin Anesth. 2016;34:227–31.

    Article  CAS  PubMed  Google Scholar 

  9. Wu L, Huang X, Sun L. The efficacy of N-methyl-D-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis. J Clin Anesth. 2015;27:311–24.

    Article  CAS  PubMed  Google Scholar 

  10. Richebé P, Capdevila X, Rivat C. Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology. 2018;129:590–607.

    Article  PubMed  Google Scholar 

  11. van Gulik L, Ahlers SJ, van de Garde EM, Bruins P, van Boven WJ, Tibboel D, et al. Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr after sternotomy. Br J Anaesth. 2012;109:616–22.

    Article  PubMed  CAS  Google Scholar 

  12. Harrogate SR, Cooper JA, Zawadka M, Anwar S. Seven-year follow-up of persistent postsurgical pain in cardiac surgery patients: a prospective observational study of prevalence and risk factors. Eur J Pain. 2021;25:1829–38.

    Article  PubMed  Google Scholar 

  13. Namiranian K, Siglin J, Sorkin JD. The incidence of persistent postoperative opioid use among U.S. veterans: a national study to identify risk factors. J Clin Anesth. 2021;68:110079.

    Article  CAS  PubMed  Google Scholar 

  14. Brown EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127:1246–58.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mauermann E, Ruppen W, Bandschapp O. Different protocols used today to achieve total opioid-free general anesthesia without locoregional blocks. Best Pract Res Clin Anaesthesiol. 2017;31:533–45.

    Article  PubMed  Google Scholar 

  16. Hung KC, Wu SC, Chiang MH, Hsu CW, Chen JY, Huang PW, et al. Analgesic efficacy of gabapentin and pregabalin in patients undergoing laparoscopic bariatric surgeries: a systematic review and meta-analysis. Obes Surg. 2022.

  17. Hung KC, Wu SC, Chang PC, Chen IW, Hsing CH, Lin CM, et al. Impact of intraoperative ketamine on postoperative analgesic requirement following bariatric surgery: a meta-analysis of randomized controlled trials. Obes Surg. 2021;31:5446–57.

    Article  PubMed  Google Scholar 

  18. Hung KC, Chang YJ, Chen IW, Chang YP, Chiu SF, Sun CK. Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies. Surg Obes Relat Dis. 2022;18:135–47.

    Article  PubMed  Google Scholar 

  19. Grape S, Kirkham KR, Frauenknecht J, Albrecht E. Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis. Anaesthesia. 2019;74:793–800.

    Article  CAS  PubMed  Google Scholar 

  20. Massoth C, Schwellenbach J, Saadat-Gilani K, Weiss R, Pöpping D, Küllmar M, et al. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy—a randomised controlled trial. J Clin Anesth. 2021;75:110437.

    Article  CAS  PubMed  Google Scholar 

  21. Lv H, Yin P, Long A, Gao Y, Zhao Z, Li J, et al. Clinical characteristics and risk factors of postoperative pneumonia after hip fracture surgery: a prospective cohort study. Osteoporos Int. 2016;27:3001–9.

    Article  CAS  PubMed  Google Scholar 

  22. Frauenknecht J, Kirkham KR, Jacot-Guillarmod A, Albrecht E. Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis. Anaesthesia. 2019;74:651–62.

    Article  CAS  PubMed  Google Scholar 

  23. Olausson A, Svensson CJ, Andréll P, Jildenstål P, Thörn SE, Wolf A. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2022;66:170–85.

    Article  PubMed  Google Scholar 

  24. Campbell AL, Yu S, Karia R, Iorio R, Stuchin SA. The effects of body mass index on pain control with liposomal bupivacaine in hip and knee arthroplasty. J Arthroplasty. 2018;33:1033–9.

    Article  PubMed  Google Scholar 

  25. Majchrzak M, Brzecka A, Daroszewski C, Błasiak P, Rzechonek A, Tarasov VV, et al. Increased pain sensitivity in obese patients after lung cancer surgery. Front Pharmacol. 2019;10:626.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008;74:834–8.

    Article  PubMed  Google Scholar 

  27. Kaw R, Chung F, Pasupuleti V, Mehta J, Gay PC, Hernandez AV. Meta-analysis of the association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth. 2012;109:897–906.

    Article  CAS  PubMed  Google Scholar 

  28. Blake DW, Chia PH, Donnan G, Williams DL. Preoperative assessment for obstructive sleep apnoea and the prediction of postoperative respiratory obstruction and hypoxaemia. Anaesth Intensive Care. 2008;36:379–84.

    Article  CAS  PubMed  Google Scholar 

  29. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268–86

  30. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Coté CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006;104:1081–93; quiz 117–8.

  31. Hung KC, Yew M, Lin YT, Chen JY, Wang LK, Chang YJ, et al. Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials. Br J Anaesth. 2022;128:644–54.

    Article  CAS  PubMed  Google Scholar 

  32. Hung KC, Chang YJ, Chen IW, Soong TC, Ho CN, Hsing CH, et al. Efficacy of high flow nasal oxygenation against hypoxemia in sedated patients receiving gastrointestinal endoscopic procedures: a systematic review and meta-analysis. J Clin Anesth. 2022;77:110651.

    Article  PubMed  Google Scholar 

  33. Hung KC, Chang YJ, Chen IW, Lin CM, Liao SW, Chin JC, et al. Comparison of video-stylet and video-laryngoscope for endotracheal intubation in adults with cervical neck immobilisation: a meta-analysis of randomised controlled trials. Anaesth Crit Care Pain Med. 2021;40:100965.

    Article  PubMed  Google Scholar 

  34. Grape S, Kirkham KR, Baeriswyl M, Albrecht E. The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta-analysis. Anaesthesia. 2016;71:1198–209.

    Article  CAS  PubMed  Google Scholar 

  35. Baeriswyl M, Kirkham KR, Kern C, Albrecht E. The analgesic efficacy of ultrasound-guided transversus abdominis plane block in adult patients: a meta-analysis. Anesth Analg. 2015;121:1640–54.

    Article  PubMed  Google Scholar 

  36. Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anesth. 2006;18:24–8.

    Article  CAS  PubMed  Google Scholar 

  37. Feld JM, Laurito CE, Beckerman M, Vincent J, Hoffman WE. Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can J Anesth. 2003;50:336–41.

    Article  PubMed  Google Scholar 

  38. Ahmed SA, Abdelghany MS, Afandy ME. The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: a randomized controlled double-blind study. J Opioid Manag. 2022;18:47–56.

    Article  PubMed  Google Scholar 

  39. Ibrahim M, Elnabtity AM, Hegab A, Alnujaidi OA, El Sanea O. Combined opioid free and loco-regional anaesthesia enhances the quality of recovery in sleeve gastrectomy done under ERAS protocol: a randomized controlled trial. BMC Anesthesiol. 2022;22:1–10.

    Article  CAS  Google Scholar 

  40. Mansour MA, Mahmoud AA, Geddawy M. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: a randomized double-blind study. Saudi J Anaesth. 2013;7:387–91.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mulier JP, Wouters R, Dillemans B, Dekock M. A randomized controlled, double-blind trial evaluating the effect of opioid-free versus opioid general anaesthesia on postoperative pain and discomfort measured by the QoR-40. J Clinical Anesthesia Pain Med. 2018;6:2.

    Google Scholar 

  42. Soudi AM, Hammad RA, ElShafie MA, Ahmed IMAS, Alhadidy MA. Comparing opioid free general anesthesia to traditional balanced general anesthesia regarding achievement of enhanced recovery in laparoscopic bariatric surgeries. Ain-Shams J Anesthesiol. 2022;14:1–7.

    Article  Google Scholar 

  43. Ziemann-Gimmel P, Goldfarb A, Koppman J, Marema R. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth. 2014;112:906–11.

    Article  CAS  PubMed  Google Scholar 

  44. Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and risks of bariatric surgery in adults: a review. JAMA. 2020;324:879–87.

    Article  PubMed  Google Scholar 

  45. Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis. PLoS Med. 2020;17:e1003206.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Joris JL, Hinque VL, Laurent PE, Desaive CJ, Lamy ML. Pulmonary function and pain after gastroplasty performed via laparotomy or laparoscopy in morbidly obese patients. Br J Anaesth. 1998;80:283–8.

    Article  CAS  PubMed  Google Scholar 

  47. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998;5:1086–90.

    Article  CAS  PubMed  Google Scholar 

  48. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77:1048–56.

    CAS  PubMed  Google Scholar 

  49. Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016;40:2065–83.

    Article  CAS  PubMed  Google Scholar 

  50. Schuligoi R, Jocic M, Heinemann A, Schöninkle E, Pabst MA, Holzer P. Gastric acid-evoked c-fos messenger RNA expression in rat brainstem is signaled by capsaicin-resistant vagal afferents. Gastroenterology. 1998;115:649–60.

    Article  CAS  PubMed  Google Scholar 

  51. Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology. 2014;81:410–8.

    Article  Google Scholar 

  52. Forrest JB, Rehder K, Cahalan MK, Goldsmith CH. Multicenter study of general anesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology. 1992;76:3–15.

    Article  CAS  PubMed  Google Scholar 

  53. Nagappa M, Weingarten TN, Montandon G, Sprung J, Chung F. Opioids, respiratory depression, and sleep-disordered breathing. Best Pract Res Clin Anaesthesiol. 2017;31:469–85.

    Article  PubMed  Google Scholar 

  54. Dang JT, Szeto VG, Elnahas A, Ellsmere J, Okrainec A, Neville A, et al. Canadian consensus statement: enhanced recovery after surgery in bariatric surgery. Surg Endosc. 2020;34:1366–75.

    Article  PubMed  Google Scholar 

  55. Berger ER, Huffman KM, Fraker T, Petrick AT, Brethauer SA, Hall BL, et al. Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 admissions in the metabolic and bariatric surgery accreditation and quality improvement program. Ann Surg. 2018;267:122–31.

    Article  PubMed  Google Scholar 

  56. Saunders JK, Ballantyne GH, Belsley S, Stephens D, Trivedi A, Ewing DR, et al. 30-day readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass. Obes Surg. 2007;17:1171–7.

    Article  PubMed  Google Scholar 

  57. Torre A, Marengo M, Ledingham NS, Ajani C, Volontè F, Garofalo F, et al. Opioid-free anesthesia in bariatric surgery: a propensity score-matched analysis. Obes Surg. 2022;32:1673–80.

    Article  PubMed  Google Scholar 

  58. Chang CC, Yen WT, Lin YT, Wang LK, Hung KC, Wu ZF, et al. Perioperative pregabalin for preventive analgesia in breast cancer surgery: a meta-analysis of randomized controlled trials. Clin J Pain. 2020;36:968–77.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. I.-Wen Chen and Cheuk-Kwan Sun contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology, Chi Mei Medical Center, Tainan City, 71004, Taiwan

    Kuo-Chuan Hung, Chien-Ming Lin, Shu-Wei Liao & I.-Chia Teng

  2. Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, 71710, Taiwan

    Kuo-Chuan Hung

  3. Department of General Surgery, E-Da Cancer Hospital, Kaohsiung City, 82445, Taiwan

    Chong-Chi Chiu

  4. School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, 84001, Taiwan

    Chong-Chi Chiu & Cheuk-Kwan Sun

  5. Department of Medical Education and Research, E-Da Cancer Hospital, Kaohsiung City, 82445, Taiwan

    Chong-Chi Chiu

  6. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, 83301, Taiwan

    Chih-Wei Hsu

  7. Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, 73657, Taiwan

    I.-Wen Chen

  8. Department of Emergency Medicine, E-Da Hospital, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan

    Cheuk-Kwan Sun

Authors
  1. Kuo-Chuan Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chong-Chi Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chih-Wei Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chien-Ming Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shu-Wei Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. I.-Chia Teng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. I.-Wen Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cheuk-Kwan Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, K.-C.H. and C.-C.C.; methodology, C.-W.H.; software, C.-M.L.; formal analysis, I.-W.C.; data curation, S.-W.L. and I.-C.T.; writing—original draft preparation, K.-C.H., I.-W.C., and C.-K.S.; writing—review and editing, K.-C.H., I.-W.C., and C.-K.S. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Cheuk-Kwan Sun.

Ethics declarations

Ethics Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent to Participate

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hung, KC., Chiu, CC., Hsu, CW. et al. Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of Randomized Controlled Studies. OBES SURG 32, 3113–3124 (2022). https://doi.org/10.1007/s11695-022-06213-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-022-06213-7

Keywords

Search

Navigation