A randomized trial with opioid-free versus opioid anesthesia in morbidly obese patients during laparoscopic cholecystectomy

Abstract

ObjectivesThe present study is scheduled to compare the analgesic and sedative effects of opioid and dexmedetomidine during the perioperative period and also to compare the recovery characteristics and hemodynamics as secondary outcomes.BackgroundObesity is a risk factor for many diseases and complications including general anesthesia-related complications. Opioids have been used as part of balanced anesthesia and have known undesired side effects. Opioid-free anesthesia is an anesthetic technique without intraoperative systemic, neuraxial, or intracavitary opioids.Patients and methodsThis study was conducted during the period from June 2020 till May 2021 to compare the effectiveness of opioid-free anesthesia versus opioid-based general anesthesia on 60 morbidly obese patients of BMI more than 35 kg/m2, American Society of Anesthesiologists III, in the age range from 20 to 60 years and were undergoing laparoscopic cholecystectomy under general anesthesia. The patients were divided into two equal groups: group A for opioid-based anesthesia group (OA) (n = 30). They received general anesthesia with propofol, muscle relaxant, and fentanyl as the main anesthetic adjuvant and analgesic and group B for opioid-free anesthesia (OFA) (n = 30). They received general anesthesia with propofol, muscle relaxant, dexmedetomidine, ketamine and lidocaine as anesthetic adjuvant and analgesic.ResultsOpioid-free anesthesia provided perioperative hemodynamic stability, postoperative pain relief, less incidence of postoperative nausea and vomiting, acceptable patient sedation, satisfaction, and less analgesic consumption postoperatively than that of the opioid-based anesthesia in morbidly obese patients.ConclusionOpioid-free anesthesia may be an attractive solution for anesthesia management of the morbidly obese patients undergoing general anesthesia.