Comparison of Opioid-Free Versions of Total Intravenous Anesthesia and Inhalational Anesthesia in Bariatric Surgery: A Randomized Controlled Trial.
Opioid-free total intravenous anesthesia caused more prolonged emergence than opioid-free sevoflurane anesthesia
Comparison of Opioid-Free Versions of Total Intravenous Anesthesia and Inhalational Anesthesia in Bariatric Surgery: A Randomized Controlled Trial.
Opioid-free anesthesia (opioid-free anesthesia) is increasingly used in bariatric surgery to prevent opioid-related adverse effects.
In this single-center randomized controlled trial, 256 patients undergoing laparoscopic sleeve gastrectomy received either opioid-free anesthesia with total intravenous anesthesia (propofol via Schnider TCI model) or opioid-free anesthesia with sevoflurane.
The primary endpoint, postoperative nausea and/or vomiting within 24 h, did not differ between groups and occurred in 80/123 patients (65.0%) in the Sevo group and 86/133 patients (64.7%) in the total intravenous anesthesia group (difference 0.4% points, 95% CI - 11.2 to 11.9; p = 1.000).
Postoperative pain scores and 24-hour opioid consumption were low and comparable.
Hemodynamic events and rescue analgesic requirements were similar.
Opioid-free total intravenous anesthesia or opioid-free inhalational anesthesia with sevoflurane provide effective and safe anesthesia for bariatric surgery, with comparable pain control and opioid-sparing effects.
High postoperative nausea and vomiting incidence persists despite opioid-free anesthesia, underscoring the need for enhanced prophylaxis.
Emergence was modestly slower with total intravenous anesthesia, which may be related to known limitations of conventional target-controlled infusion models in patients with severe obesity and warrants further study.