Effects of an opioid-free care pathway vs. opioid-based standard care on postoperative pain and postoperative quality of recovery after laparoscopic bariatric surgery : A multicentre randomised controlled trial
(2025) In European Journal of Anaesthesiology p.1-13- Abstract
BACKGROUND: Opioid-free anaesthesia (OFA) may enhance postoperative recovery after bariatric surgery, but its combined effect with opioid-free interventions has not been studied.
OBJECTIVES: To compare postoperative pain and recovery after laparoscopic bariatric surgery with a total opioid-free care pathway and conventional opioid-based treatment.
DESIGN: A multicentre nonblinded controlled trial.
SETTING: Two university hospitals in Sweden.
PATIENTS: Adult patients scheduled for laparoscopic bariatric surgery were enrolled between May 2019 and November 2023. Of 837 patients screened, 112 were randomised, and 110 were included in the analysis: 55 in the intervention and 55 in the control... (More)
BACKGROUND: Opioid-free anaesthesia (OFA) may enhance postoperative recovery after bariatric surgery, but its combined effect with opioid-free interventions has not been studied.
OBJECTIVES: To compare postoperative pain and recovery after laparoscopic bariatric surgery with a total opioid-free care pathway and conventional opioid-based treatment.
DESIGN: A multicentre nonblinded controlled trial.
SETTING: Two university hospitals in Sweden.
PATIENTS: Adult patients scheduled for laparoscopic bariatric surgery were enrolled between May 2019 and November 2023. Of 837 patients screened, 112 were randomised, and 110 were included in the analysis: 55 in the intervention and 55 in the control group.
INTERVENTIONS: Patients were randomised to an opioid-based standard care (control group) or to an opioid-free care pathway (intervention group), including intraoperative OFA and postoperative first-line transcutaneous electrical nerve stimulation (TENS) treatment.
MAIN OUTCOME MEASURES: The primary outcome was the change in patient-reported postoperative pain intensity on a numerical rating scale (NRS) from arrival in the postanaesthesia care unit (PACU) until discharge to the surgical ward. Key secondary outcomes were postoperative pain intensity, in-hospital opioid consumption, and postoperative quality of recovery scale (PQRS) scores.
RESULTS: There was no difference between the groups regarding the changes in pain intensity from arrival in PACU until discharge to the ward, with mean ± SD changes in NRS of 3.20 ± 3.01 (intervention) vs. 3.15 ± 2.25 (control); mean difference (MD) 0.04 [(95% confidence interval (CI), -1.00 to 1.08); P = 0.97], and pain intensity at 24 h (P = 0.078), 72 h (P = 0.060), and 3 months (P = 0.30) postoperatively. The intervention group had a significantly lower opioid consumption in the PACU; mean morphine equivalents 6.08 ± 12.31 vs. 51.1 ± 14.9 mg; MD -45.0 (95% CI, -50.1 to -39.8) mg; P < 0.0001; and during the hospital stay MD -40.3 (95% CI, -54.4 to -25.9) mg; P < 0.0001. Total PQRS scores did not differ significantly over the 3-month follow-up.
CONCLUSION: The opioid-free care pathway offers patients pain relief and recovery outcomes comparable to conventional opioid-based care and reduces opioid use after laparoscopic bariatric surgery.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03756961.
(Less)
- author
- Olausson, Alexander ; Jildenstål, Pether LU ; Andréll, Paulin ; Angelini, Eva ; Stenberg, Erik ; Wallenius, Ville ; Öhrström, Henrik ; Thörn, Sven-Egron and Wolf, Axel
- organization
- publishing date
- 2025-05-15
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- European Journal of Anaesthesiology
- pages
- 1 - 13
- publisher
- European Society of Anaesthesiology
- external identifiers
-
- scopus:105005881502
- pmid:40371564
- ISSN
- 1365-2346
- DOI
- 10.1097/EJA.0000000000002193
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.
- id
- 4ea1d12a-b5de-489c-b31b-253f558d0c30
- date added to LUP
- 2025-06-10 07:24:33
- date last changed
- 2025-07-09 07:00:24
@article{4ea1d12a-b5de-489c-b31b-253f558d0c30,
abstract = {{<p>BACKGROUND: Opioid-free anaesthesia (OFA) may enhance postoperative recovery after bariatric surgery, but its combined effect with opioid-free interventions has not been studied.</p><p>OBJECTIVES: To compare postoperative pain and recovery after laparoscopic bariatric surgery with a total opioid-free care pathway and conventional opioid-based treatment.</p><p>DESIGN: A multicentre nonblinded controlled trial.</p><p>SETTING: Two university hospitals in Sweden.</p><p>PATIENTS: Adult patients scheduled for laparoscopic bariatric surgery were enrolled between May 2019 and November 2023. Of 837 patients screened, 112 were randomised, and 110 were included in the analysis: 55 in the intervention and 55 in the control group.</p><p>INTERVENTIONS: Patients were randomised to an opioid-based standard care (control group) or to an opioid-free care pathway (intervention group), including intraoperative OFA and postoperative first-line transcutaneous electrical nerve stimulation (TENS) treatment.</p><p>MAIN OUTCOME MEASURES: The primary outcome was the change in patient-reported postoperative pain intensity on a numerical rating scale (NRS) from arrival in the postanaesthesia care unit (PACU) until discharge to the surgical ward. Key secondary outcomes were postoperative pain intensity, in-hospital opioid consumption, and postoperative quality of recovery scale (PQRS) scores.</p><p>RESULTS: There was no difference between the groups regarding the changes in pain intensity from arrival in PACU until discharge to the ward, with mean ± SD changes in NRS of 3.20 ± 3.01 (intervention) vs. 3.15 ± 2.25 (control); mean difference (MD) 0.04 [(95% confidence interval (CI), -1.00 to 1.08); P = 0.97], and pain intensity at 24 h (P = 0.078), 72 h (P = 0.060), and 3 months (P = 0.30) postoperatively. The intervention group had a significantly lower opioid consumption in the PACU; mean morphine equivalents 6.08 ± 12.31 vs. 51.1 ± 14.9 mg; MD -45.0 (95% CI, -50.1 to -39.8) mg; P < 0.0001; and during the hospital stay MD -40.3 (95% CI, -54.4 to -25.9) mg; P < 0.0001. Total PQRS scores did not differ significantly over the 3-month follow-up.</p><p>CONCLUSION: The opioid-free care pathway offers patients pain relief and recovery outcomes comparable to conventional opioid-based care and reduces opioid use after laparoscopic bariatric surgery.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov NCT03756961.</p>}},
author = {{Olausson, Alexander and Jildenstål, Pether and Andréll, Paulin and Angelini, Eva and Stenberg, Erik and Wallenius, Ville and Öhrström, Henrik and Thörn, Sven-Egron and Wolf, Axel}},
issn = {{1365-2346}},
language = {{eng}},
month = {{05}},
pages = {{1--13}},
publisher = {{European Society of Anaesthesiology}},
series = {{European Journal of Anaesthesiology}},
title = {{Effects of an opioid-free care pathway vs. opioid-based standard care on postoperative pain and postoperative quality of recovery after laparoscopic bariatric surgery : A multicentre randomised controlled trial}},
url = {{http://dx.doi.org/10.1097/EJA.0000000000002193}},
doi = {{10.1097/EJA.0000000000002193}},
year = {{2025}},
}