Comparison of Opioid-based and Opioid-free TIVA for Laparoscopic Urological Procedures in Obese Patients

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2020 Jan 11

PMID 31920231

Citations 13

Authors

Shaman Bhardwaj

Kamakshi Garg

Sumeet Devgan

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Perioperative pain management in an obese patient is challenging. The incidence of respiratory depression is higher in obese patients and is exaggerated with opioids. We evaluated the efficacy of opioid-free anesthesia with propofol, dexmedetomidine, lignocaine, and ketamine in obese patients undergoing urological laparoscopic procedures with reference to postoperative analgesic consumption, hemodynamic stability, and respiratory depression.

Material And Methods: In this prospective, randomized, blinded controlled study, patients were randomized to receive either opioid-based (opioid group) or opioid-free (opioid-free group) anesthesia. Postoperative pain was assessed using visual analog score (VAS) 30 min after recovery, hourly for 2 h and every 4 hourly for 24 h. The primary outcomes studied were respiratory depression, mean analgesic consumption and time to rescue analgesia. Intraoperative hemodynamic parameters, mean SpO, respiratory rate and postanesthesia care unit (PACU) discharge time were secondary objectives.

Results: There were no differences in the demographic and intraoperative hemodynamic profile between the groups. Incidence of respiratory depression, defined as fall in saturation, was more in opioid-based group. Postoperative analgesic requirement (225 ± 48.4 vs 63.6 ± 68.5 mg of tramadol with value of <0.001) and PACU discharge times (18.1 ± 5.4 vs 11.7 ± 4.3 hours with value of <0.001) were significantly less in the opioid-free group.

Conclusions: Opioid-free anesthesia is a safer and better form of anesthesia in obese patients undergoing laparoscopic urological procedures as there is a lower requirement of postoperative analgesia.

Citing Articles

Opioid-Free Anesthesia for Upper Limb Surgery in Obese Patients as a Day Case Surgery: A Prospective Observational Study.

Ahmed Abdelghaffar R, Ahmed Hamed M, Magdy Basiony M, Fouad Algyar M, Sayed Fargaly O, Ahmed Shawky M Anesth Pain Med. 2025; 14(6):e150997.

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Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis.

da Silveira C, Rasador A, Medeiros H, Slawka E, Gesteira L, Pereira L Can J Anaesth. 2024; 71(11):1466-1485.

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Preoperative bedside test indicators as predictors of difficult video laryngoscopy in obese patients: a prospective observational study.

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Xue Z, Yan C, Liu Y, Yang N, Zhang G, Qian W BMC Surg. 2024; 24(1):228.

PMID: 39127614 PMC: 11316359. DOI: 10.1186/s12893-024-02518-9.

Opioid-free anesthesia using a combination of ketamine and dexmedetomidine in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.

K R V, Singh K, Sahay N, Sinha C, Kumar A, Kumar N Anesth Pain Med (Seoul). 2024; 19(2):109-116.

PMID: 38725165 PMC: 11089293. DOI: 10.17085/apm.23097.

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