Comparative Study between Opioid-Free Anesthesia and Opioid-Based Anesthesia in Obese Patients Undergoing Abdominal Laparoscopic Surgery? Effective and Safe Analgesia Challenge: A Randomized Double Blinded Study

Abstract

Background: Opioid-free anesthesia (OFA) has emerged as a potential alternative treatment for obese individuals undergoing  laparoscopic abdominal surgery.

Objective: The goal of this work aimed to compare the safety and efficacy of opioid-based anesthesia (OBA) versus OFA in obese patients having laparoscopic cholecystectomy.

Material and methods: This randomized, prospective, double-blind clinical study was conducted with 50 obese patients scheduled for  laparoscopic cholecystectomy. Patients were randomly assigned to either the opioid-based anesthesia group (Group I) or the opioid-free  anesthesia group (Group II). Group I obtained fentanyl as the primary anesthetic adjuvant and perioperative analgesic, while group II  obtained dexmedetomidine, lidocaine, and paracetamol as alternative analgesics. Hemodynamic parameters, pain scores, and opioid  usage were measured at various time points. Adverse effects were also captured.

Results: OFA resulted in significantly lower mean  arterial blood pressure and significantly lower postoperative VAS score. The total consumption of opioid in the form of pethidine was  significantly reduced in the OFA group than the OBA group (40.4 ± 28.21 vs. 71.8 ± 35.73 respectively, P <0.001). However, a slightly  superior recovery score was observed in the OBA group (median; 6.7 vs. 7.25, P=0.008). No statistically significant difference was  discovered between the two groups for any side effects, including postoperative nausea and vomiting (C) (P-value > 0.05).

Conclusions: Anesthesia management for morbidly obese individuals undergoing laparoscopic cholecystectomy under general  anesthesia may benefit from the use of anesthesia devoid of opioids.