Comparison of Opioid-Free Versions of Total Intravenous Anesthesia and Inhalational Anesthesia in Bariatric Surgery: A Randomized Controlled Trial
Abstract
Background: Opioid-free anesthesia (OFA) is increasingly used in bariatric surgery to prevent opioid-related adverse effects. Although both propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane are compatible with OFA protocols, their relative opioid-free effectiveness is unclear.
Methods: In this single-center randomized controlled trial, 256 patients undergoing laparoscopic sleeve gastrectomy received either OFA with TIVA (propofol via Schnider TCI model) or OFA with sevoflurane. Both groups received identical nonopioid adjuncts (lidocaine, ketamine, dexmedetomidine). The primary outcome was the incidence of postoperative nausea and vomiting (PONV) within 24 h. Secondary outcomes included pain scores, opioid consumption, hemodynamic stability, and emergence characteristics.
Results: 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 TIVA group (difference 0.4% points, 95% CI - 11.2 to 11.9; p = 1.000). Rates of postoperative nausea (65.0% vs. 63.2%; p = 0.855) and vomiting (25.2% vs. 26.3%; p = 0.952) were likewise similar. Postoperative pain scores and 24-hour opioid consumption were low and comparable. Hemodynamic events and rescue analgesic requirements were similar. However, prolonged emergence (> 10 min) was more frequent in the TIVA group than in the Sevo group (22.6% vs. 12.2%;…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 256 participants or records.
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