Justification of the expediency of using harmless analgesia in bariatric surgery: prospective randomized study

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


BACKGROUND: The presence of various comorbid conditions in patients with obesity increases operational risk, and high sensitivity to sedatives and opioid drugs can contribute to their aggravation.

OBJECTIVE: To compare and evaluate two methods of perioperative analgesia, namely, multimodal without opioid and non-opioid when performing longitudinal gastric resection for patients with morbid obesity using the enhanced recovery after surgery protocol.

MATERIALS AND METHODS: A prospective randomized study of patients with morbid obesity was conducted. Depending on the type of analgesic component of anesthesia, the patients are divided into two groups. In both groups, low-flow desflurane inhalation was used; in group 1 (n=30), the technique of non-opioid analgesia was used, which included intraoperative infusion of ketamine, dexmedetomidine, lidocaine, and magnesium sulfate. In group 2 (n=30), traditional combined anesthesia using fentanyl was administered. In the postoperative period, the infusion of the above drugs continued for 10 h in group 1. Central and peripheral hemodynamic parameters, and the depth of anesthesia were studied, and TOF-monitoring was carried out. Postoperative rehabilitation was assessed based on the time of extubation, achievement of 13 points on the PARS scale, first getting up on one’s feet, appearance of overstrain, and gas discharge. Postoperative analgesia was assessed on a 10-point visual analog scale, and anesthesia-related complications were recorded.

RESULTS: Surgical intervention under low-flow inhalation anesthesia based on desflurane in combination with multimodal opioid-free analgesia reduced the need for opioid analgesics intraoperatively (in group 1, the fentanyl dose was 0.2 [01; 0.2] mg; in group 2 — 0.4 [0.3; 0.5] mg; p=0.002), provided less fluctuation of intraoperative hemodynamic parameters (AvBP: stage 1: group 1 — 102 [100; 103]; group 2 — 102 [98; 105], p=0.96; stage 2: group 1 — 93 [90; 95]; group 2 — 96 [93; 99], p=0.003; stage 3: group 1 — 95 [95; 97]; group 2 — 100 [96; 102], p <0.001; stage 4: group 1 — 95 [92; 97]; group 2 — 98 [98; 101], p <0.001; CI stage 1: group 1 — 49±2.2; group 2 — 49.5±2.2, p=0.39; stage 2: group 1 — 44.4±2; group 2 — 44.6±2.1, p=0.26; stage 3: group 1 — 45.5±2.11; group 2 — 50.6±2.8, p=0.001; stage 4: group 1 — 44.5±2.1; group 2 — 48.8±2.5 p <0.001), and contributed to a lower level of pain and faster rehabilitation. In addition, anesthesia-related complications such as postoperative nausea and vomiting, hypoxemia, and dysphoria were less frequently recorded.

CONCLUSION: The use of multimodal non-opioid analgesia contributes to a lesser fluctuation in hemodynamic parameters, a low level of postoperative pain, early activation of patients and restoration of peristalsis, and a decrease in the number of postoperative complications in patients who underwent longitudinal gastric resection for morbid obesity.

Full Text

Restricted Access

About the authors

Mikhail I. Neimark

Altai State Medical University

Email: mineimark@mail.ru
ORCID iD: 0000-0001-9135-6392
SPIN-code: 5880-0554

MD, Dr. Sci. (Med.), Professor

Russian Federation, Barnaul

Sergey V. Zhilin

Clinical Hospital «Russian Railways-Medicine»

Author for correspondence.
Email: sergejzhilin91@bk.ru
ORCID iD: 0000-0003-1019-3574
SPIN-code: 2918-9854

doctor of the department of anesthesiology and resuscitation

Russian Federation, 20 Molodezhnaya Str., 656038, Barnaul


  1. Dedov II, Mel’nichenko GA, Shestakova MV, et al. Russian National clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). Obesity and metabolism. 2018;15(1):53–70. (In Russ). doi: 10.14341/omet2018153-70
  2. Demidova TY, Plakhotnyaya VM. Current aspects of pre- and postoperative management of patients scheduled for bariatric surgery. FOCUS Endocrinology. 2021;1:8–18. (In Russ). doi: 10.47407/ef2021.2.1.0018
  3. Zabolotskikh IB, Anisimov MA, Gorobets ES, et al. Perioperative management of patients with concomitant morbid obesity. Guidelines of the All-Russian public organization «Federation of Anesthesiologists and Reanimatologists». Annals of Critical Care. 2021;1:7–18.(In Russ). doi: 10.21320/1818-474X-2021-1-7-18
  4. Pouwels S, Buise MP, Twardowski P, et al. Obesity Surgery and Anesthesiology Risks: a Review of Key Concepts and Related Physiology. Obes Surg. 2019;29(8):2670–2677. doi: 10.1007/s11695-019-03952-y
  5. Epshtein SL, Azarova TM, Storozhev VY, et al. General anesthesia without opioids in surgery for morbid obesity. What for and how? Regional Anesthesia and Acute Pain Management. 2016;10(1):47–54. (In Russ). doi: 10.17816/RA42809
  6. Wick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg. 2017;152(7):691–697. doi: 10.1001/jamasurg.2017.0898
  7. Siotos C, Stergios K, Naska A, et al. The impact of fast track protocols in upper gastrointestinal surgery: A meta-analysis of observational studies. Surgeon.2018;16(3):183–192. doi: 10.1016/j.surge.2017.12.001
  8. Golbraych VA, Maskin SS, Arutyunyan AG. Algorithms of the «fast track» program in plane and emergency abdominal surgery. Journal of Volgograd State Medical University. 2019;71(3):3–8. (In Russ). doi: 10.19163/1994-9480-2019-3(71)-3-8
  9. Tarasova IA, Tskhovrebov AT, Nikoda VV, Shestakov AL. Implementation of Enhanced Recovery after Surgery (ERAS) protocol in patients after esophagectomy (analytical review). Clinical and Experimental Surgery. Petrovsky Journal. 2017;5(2):83–92. (In Russ). doi: 10.24411/2308-1198-2017-00038
  10. Baek SY, Kim JW, Kim TW, et al. Opioid-free anesthesia with a mixture of dexmedetomidine, ketamine, and lidocaine in one syringe for surgery in obese patients. J Int Med Res. 2020;48(10):300060520967830. doi: 10.1177/0300060520967830
  11. Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. AnesthAnalg. 2018;127(5):1246–1258. doi: 10.1213/ANE.0000000000003668
  12. Mulier J. Opioid free general anesthesia: A paradigm shift? Rev Esp Anestesiol Reanim. 2017;64(8):427–430.doi: 10.1016/j.redar.2017.03.004
  13. Ovechkin AM, Yavorovskii AG. Bezopioidnaya analgeziya v sovremennoi khirurgii — ot teorii k praktike. Moscow: GEOTAR-Media; 2022. (In Russ).
  14. Campos-Pérez W, Ramírez-Plascencia L, Pérez-Robles M, et al. A comparison of opioid-containing anesthesia versus opioid-free anesthesia using the Cortínez-Sepúlveda model on differential cytokine responses in obese patients undergoing gastric bypass surgery: a randomized controlled trial. BMC Anesthesiol. 2022;22(1):294. doi: 10.1186/s12871-022-01838-8
  15. Hirvonen EA, Nuutinen LS, Kauko M. Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy. Acta Anaesthesiol Scand. 1995;39(7):949–955. doi: 10.1111/j.1399-6576.1995.tb04203.x
  16. Mehta SD, Smyth D, Vasilopoulos T, et al. Ketamine infusion reduces narcotic requirements following gastric bypass surgery: a randomized controlled trial. Surg Obes Relat Dis. 2021;17(4):737–743. doi: 10.1016/j.soard.2020.11.027
  17. Ahmed SA, Abdelghany MS, Afandy ME. The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study. J Opioid Manag. 2022;18(1):47–56. doi: 10.5055/jom.2022.0694
  18. Tian C, Malhan RS, Deng SX, et al. Benefits of dexmedetomidine on postoperative analgesia after bariatric surgery. Minerva Anestesiol. 2022;88(3):173–183. doi: 10.23736/S0375-9393.21.15986-3
  19. Kizilcik N, Koner O. Magnesium Sulfate Reduced Opioid Consumption in Obese Patients Undergoing Sleeve Gastrectomy: a Prospective, Randomized Clinical Trial. Obes Surg. 2018;28(9):2783–2788. doi: 10.1007/s11695-018-3243-7
  20. Kurz A Sessler DI Opioid-induced bowel dysfunction: pathophysiology and potential new therapies. Drugs. 2003;63(7):649–671. doi: 10.2165/00003495-200363070-00003

Supplementary files

There are no supplementary files to display.

Copyright (c) 2023 Eco-Vector

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ ФС 77 - 55827 от 30.10.2013 г
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ЭЛ № ФС 77 - 80651 от 15.03.2021 г

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies