General anesthesia without opioids in surgery for morbid obesity. What for and how?

Abstract

The paper presents the experience of applying the technique of general opioid-free anesthesia and postoperative analgesia in bariatric laparoscopic surgery that was developed by Belgian specialists. Thirty patients with body mass index of 48±5,3 kg/M2 were operated using this technique. All of the patients underwent laparoscopic longitudinal gastrectomy. Anesthesia was induced using propofol 230±25 mg and maintained by sevoflurane in concentration of 0,7-0,9 MAC combined with 50%-65% nitrous oxide as well as multimodal analgesic infusion (0,9% NaCl 1000,0 + lidocain 600 mg + ketamine 50 mg + dexmedetomidine 100μg + MgSO4 25%-5 g) with administration rate of 1,0-1,3 ml/кгLBM/hour, where LBM - lean body mass equaled to ideal body mass (IBM). Miorelaxation was achieved using esmeron in dose of 0,6 mg/kg IBM. Reversal of neuromuscular block was performed in 10 patients using sugammadex. The infusion of analgesic solution was continued for 8-10 hours after the operation. All the patients got up and walked within a ward 4-5 hours after the surgery. The activation accompanied with increasing of pain in the operation zone and tangible discomfort in 20 patients who required the enhance of analgesia using opioids. The proposed technique facilitates the early postoperative activation that is very important for the patients suffered from morbid obesity.