Impact of opioid free anaesthesia in bariatric surgery

Authors

  • A. Malo-Manso Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.
  • J. Díaz-Crespo Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.
  • J.J. Escalona-Belmonte Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.
  • S. Romero-Molina Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.
  • J. Cruz-Mañas Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.
  • J.L. Guerrero-Orriach Servicio de Anestesiología y Reanimación. Hospital Universitario Virgen de la Victoria. Málaga.

DOI:

https://doi.org/10.23938/ASSN.0757

Keywords:

Opioids. Bariatric surgery. Postoperative pain. Post anaesthesia recovery.

Abstract

Background. Patients subjected to bariatric surgery present a greater risk of complications due to the use of opioids. The goal is to evaluate the security and suitability of the Opioid Free Anaesthesia (OFA) protocol implemented in the Hospital Universitario Virgen de la Victoria in 2018.

Method. Prospective study carried out on 38 patients subjected to laparoscopic bariatric surgery under the OFA protocol in the year 2018 at the H.U. Virgen de la Victoria (Málaga, Spain). Variables were gathered to establish haemodynamic control and perioperative pain, which were analysed using Stata v.16.

Results. The average age was 43 years, the average body mass index was 48.14 and the average stay in the operating theatre was 178 minutes. Control of hypertensive response following laryngoscopy occurred in 88.1% of the cases. On entering the Post Anaesthesia Care Unit (PACU), SpO2 without a supplementary contribution in the transfer showed a median of 97% with p75 ≥ 95%, while the p75 of pain evaluation by means of Visual Analogue Scale (VAS) was 3, with 68% of patients without pain. On discharge from the PACU, all presented VAS below 4 and it was only necessary to administer a low dose of Pethidine in seven patients.

Conclusion. The OFA has proved to be secure and achieves optimum pain control. In the reconverted cases, good control of the parameters opens up the possibility of its use in more painful surgeries.

Downloads

Download data is not yet available.

References

ODERDA GM, SAID Q, EVANS RS, STODDARD GJ, LLOYD J, JACKSON K et al. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. Ann Pharmacother 2007; 41: 400-407. https://doi.org/10.1345/aph.1H386

WEINBROUM AA. Role of anaesthetics and opioids in perioperative hyperalgesia. Eur J Anaesthesiol 2015; 32: 230-231. https://doi.org/10.1097/EJA.0000000000000231

FUNK RD, HILLIARD P, RAMACHANDRAN SK. Perioperative opioid usage. Plast Reconstr Surg 2014; 134: 32S-39S. https://doi.org/10.1097/prs.0000000000000680

MULIER JP. Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome. Curr Opin Anaesthesiol 2016; 29: 129-133. https://doi.org/10.1097/aco.0000000000000281

DHONNEUR G, COMBES X, LEROUX B, DUVALDESTIN P. Postoperative obstructive apnea. Anesth Analg 1999; 89: 762-767. https://doi.org/10.1097/00000539-199909000-00045

BENUMOF JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesth 2001; 13: 144-156. https://doi.org/10.1016/s0952-8180(01)00232-x

GOLD AR, GOLD MS, HARRIS KW, ESPELETA VJ, AMIN MM, BRODERICK JE. Hypersomnolence, insomnia and the pathophysiology of upper airway resistance syndrome. Sleep Med 2008; 9: 675-683. https://doi.org/10.1016/j.sleep.2007.08.013

ROSE DK, COHEN MM, WIGGLESWORTH DF, DEBOER DP. Critical respiratory events in the Postanesthesia Care Unit. Anesthesiology 1994; 81: 410-418. https://doi.org/10.1097/00000542-199408000-00020

BERCAULT N, BOULAIN T, KUTEIFAN K, WOLF M, RUNGE I, FLEURY JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004; 32: 998-1003. https://doi.org/10.1097/01.ccm.0000119422.93413.08

GUPTA RM, PARVIZI J, HANSSEN AD, GAY PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 2001; 76: 897-905. https://doi.org/10.4065/76.9.897

TURAN A, YOU J, EGAN C, FU A, KHANNA A, ESHRAGHI Y et al. Chronic intermittent hypoxia is independently associated with reduced postoperative opioid consumption in bariatric patients suffering from sleep-disordered breathing. PLoS One 2015; 10: e0127809. https://doi.org/10.1371/journal.pone.0127809

GALLAGHER SF, HAINES KL, OSTERLUND LG, MULLEN M, DOWNS JB. Postoperative hypoxemia: common, undetected, and unsuspected after bariatric surgery. J Surg Res 2010; 159: 622-626. https://doi.org/10.1016/j.jss.2009.09.003

AHMAD S, NAGLE A, MCCARTHY RJ, FITZGERALD PC, SULLIVAN JT, PRYSTOWSKY J. Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 2008; 107: 138-143. https://doi.org/10.1213/ane.0b013e318174df8b

World Health Organization. Global status report on alcohol and health 2014. Poznyak V, Rekve D, editors. Luxembourg: World Health Organization, 2014. https://apps.who.int/iris/bitstream/handle/10665/112736/9789240692763_eng.pdf?sequence=1

NG M, FLEMING T, ROBINSON M, THOMSON B, GRAETZ N, MARGONO C et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 766-781. https://doi.org/10.1016/S0140-6736(14)60460-8

BERRINGTON DE GONZALEZ A, HARTGE P, CERHAN JR, FLINT AJ, HANNAN L, MACINNIS RJ et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med 2010; 363: 2211-2219. https://doi.org/10.1056/NEJMoa1000367

BUCHWALD H, AVIDOR Y, BRAUNWALD E, JENSEN MD, PORIES W, FAHRBACH K et al. Bariatric surgery. JAMA 2004; 292: 1724. https://doi.org/10.1001/jama.292.14.1724

CHRISTOU NV, SAMPALIS JS, LIBERMAN M, LOOK D, AUGER S, MCLEAN APH et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004; 240: 416-424. https://doi.org/10.1097/01.sla.0000137343.63376.19

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: 2065-2083. https://doi.org/10.1007/s00268-016-3492-3

MAŁCZAK P, PISARSKA M, PIOTR M, WYSOCKI M, BUDZYŃSKI A, PĘDZIWIATR M. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg 2017; 27: 226-235. https://doi.org/10.1007/s11695-016-2438-z

PIERRE S, BENAIS H, POUYMAYOU J. Apfel’s simplified score may favourably predict the risk of postoperative nausea and vomiting. Can J Anesth 2002; 49: 237-242. https://doi.org/10.1007/bf03020521

VEIGA-GIL L, PUEYO J, LÓPEZ-OLAONDO L. Náuseas y vómitos postoperatorios: fisiopatología, factores de riesgo, profilaxis y tratamiento . Rev Esp Anestesiol Reanim 2017; 64: 223-232. https://doi.org/10.1016/j.redar.2016.10.001

HALLIDAY TA, SUNDQVIST J, HULTIN M, WALLDÉN J. Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand 2017; 61: 471-479. https://doi.org/10.1111/aas.12884

RAVESLOOT MJL, VAN MAANEN JP, HILGEVOORD AAJ, VAN WAGENSVELD BA, DE VRIES N. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Oto-Rhino-Laryngology 2012; 269: 1865-1871. https://doi.org/10.1007/s00405-012-1948-0

YOUNG T, PEPPARD PE, TAHERI S. Excess weight and sleep-disordered breathing. J Appl Physiol 2005; 99: 1592-1599. https://doi.org/10.1152/japplphysiol.00587.2005

SAMUELS D, ABOU-SAMRA A, DALVI P, MANGAR D, CAMPORESI EM. Opioid-free anesthesia results in reduced post-operative opioid consumption. J Clin Anesth Pain Med 2017; 1: 005.

BHARDWAJ S, GARG K, DEVGAN S. Comparison of opioid-based and opioid-free TIVA for laparoscopic urological procedures in obese patients. J Anaesthesiol Clin Pharmacol 2019; 35: 481-486. https://doi.org/10.4103/joacp.joacp_382_18

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: 336-341. https://doi.org/10.1007/bf03021029

SALEM AM, HAFEZ MML, ELDIN AS, HAGRAS AM. Opioid-free anesthesia for laparoscopic hysterectomy: is it appropriate? J Anesth Inten Care Med 2019; 9: 555757. https://doi.org/10.19080/JAICM.2019.09.555757

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 Clin Anesth Pain Med 2018; 2: 015.

HAKIM KYK, WAHBA ZWB. Opioid-free total intravenous anesthesia improves postoperative quality of recovery after ambulatory gynecologic laparoscopy. Anesth Essays Res 2019; 13: 199-203. https://doi.org/10.4103/aer.aer_74_19

LAM KKY, MUI WLM. Multimodal analgesia model to achieve low postoperative opioid requirement following bariatric surgery. Hong Kong Med J 2016; 22 : 428-434. https://doi.org/10.12809/hkmj154769

BAKAN M, UMUTOGLU T, TOPUZ U, UYSAL H, BAYRAM M, KADIOGLU H et al. Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: Estudo prospectivo, randomizado e duplo-cego. Rev Bras Anestesiol 2015; 65: 191-199. https://doi.org/10.1016/j.bjane.2014.05.001

ZIEMANN-GIMMEL P, GOLDFARB AA, KOPPMAN J, MAREMA RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anaesth 2014; 112: 906-911. https://doi.org/10.1093/bja/aet551

TAYLOR S, KIRTON OC, STAFF I, KOZOL RA. Postoperative day one: a high risk period for respiratory events. Am J Surg 2005; 190: 752-756. https://doi.org/10.1016/j.amjsurg.2005.07.015

MULIER JP, DILLEMANS B. Anaesthetic factors affecting outcome after bariatric surgery, a retrospective levelled regression analysis. Obes Surg 2019; 29: 1841-1850 https://doi.org/10.1007/s11695-019-03763-1

DÍAZ-CRESPO J, MALO-MANSO A, BUSTAMANTE-DOMÍNGUEZ C, ESCALONA-BELMONTE JJ, CRUZ-MAÑAS J, GUERRERO-ORRIACH JL. Laparotomy in a patient under opioid-free anaesthesia. An Sist Sanit Navar 2018; 41: 259-262. https://doi.org/10.23938/ASSN.0294

Published

2020-04-20

How to Cite

1.
Malo-Manso A, Díaz-Crespo J, Escalona-Belmonte J, Romero-Molina S, Cruz-Mañas J, Guerrero-Orriach J. Impact of opioid free anaesthesia in bariatric surgery. An Sist Sanit Navar [Internet]. 2020 Apr. 20 [cited 2025 Dec. 19];43(1):51-6. Available from: https://recyt.fecyt.es/index.php/ASSN/article/view/76328

Issue

Section

Research articles

Most read articles by the same author(s)

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.