OFA vs OBA in Bariatric Surgery

Hospital HM Nou Delfos70 enrolled

Overview

This study compares two different anesthesia techniques in patients with obesity undergoing bariatric surgery: one that includes opioids (OBA), and one that avoids them completely (OFA). The main goal is to determine whether avoiding opioids during surgery leads to lower postoperative morphine requirements and fewer side effects. Researchers reviewed medical records of 70 patients who had bariatric surgery between June 2022 and December 2023 at a hospital in Spain. The study evaluates pain levels, sedation, complications, and total morphine use in the first 48 hours after surgery.

This is a single-center, retrospective, observational cohort study conducted at Hospital HM Nou Delfos (Barcelona, Spain). The aim is to compare postoperative opioid requirements and outcomes in patients with morbid obesity undergoing laparoscopic bariatric surgery, according to the intraoperative anesthesia technique used. Two anesthetic strategies were evaluated: Opioid-Free Anesthesia (OFA): Total intravenous anesthesia (TIVA) without opioids, using agents such as propofol, ketamine, dexmedetomidine, lidocaine and magnesium. Opioid-Based Anesthesia (OBA): TIVA including opioids, following institutional standards. Medical records of 70 patients (35 in each group) who underwent surgery between June 2022 and December 2023 were analyzed. Key data extracted included demographics, surgical duration, anesthetic drugs used, intraoperative complications, pain scores (VAS at 1, 2, 4, 24, and 48 hours), sedation levels (RAMSAY scale), adverse effects (e.g., nausea, vomiting, ileus, hypotension), and morphine consumption. The primary outcome is total morphine use within the first 48 hours postoperatively. Secondary outcomes include pain scores, adverse events, time to awakening, and hospital length of stay. Statistical analysis was performed using descriptive and inferential methods, including regression models adjusted for age, sex, BMI, and comorbidities. This study provides real-world evidence on the clinical impact of opioid-free anesthesia in bariatric patients, aiming to improve perioperative safety and enhance postoperative recovery.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria Age between 18 and 65 years Body Mass Index (BMI) ≥ 30 kg/m² ASA physical status II or III Underwent laparoscopic bariatric surgery under general anesthesia at HM Nou Delfos Surgery performed between June 1, 2022 and December 31, 2023 Exclusion Criteria Pregnancy or breastfeeding Chronic pain patients on high-dose opioids Known allergy to any anesthetic drug used in the study Severe hepatic (e.g., cirrhosis with portal hypertension) or renal insufficiency Untreated coagulopathy Active alcohol or drug abuse Uncontrolled or severe psychiatric illness Intraoperative complications requiring deviation from planned anesthetic technique Postoperative morphine use exceeding institutional norms for bariatric surgery

Outcomes

Primary Outcomes

Total postoperative morphine consumption (mg)

Cumulative amount of morphine (in milligrams) administered within the first 48 hours after surgery, as recorded in the post-anesthesia care unit and inpatient medical records.

Time frame: From 0 to 48 hours after surgery

Secondary Outcomes

Pain intensity (VAS)

Pain evaluated using the Visual Analog Scale (VAS) from 0 (no pain) to 10 (worst imaginable pain), both at rest and with movement.

Time frame: At 1, 2, 4, 24, and 48 hours postoperatively

Sedation level (RAMSAY scale)

Sedation assessed using the Ramsay Sedation Scale, ranging from 1 (anxious/agitated) to 6 (no response to stimuli).

Time frame: From 0 to 48 hours after surgery

Incidence of adverse events

Number of patients experiencing side effects such as nausea, vomiting, pruritus, hypotension, bradycardia, ileus, or urinary retention.

Time frame: Up to 48 hours after surgery

Length of hospital stay

Total duration of hospital stay in days, calculated from the day of surgery to discharge date.

Time frame: From surgery until discharge (up to 7 days)

Time to awakening

Time in minutes from the end of surgery until patient opens eyes or responds to verbal commands.

Time frame: Intraoperative period until recovery (measured at end of surgery)