Prerequisites and effects of an opioid-free anaesthesia pathway in patients undergoing bariatric surgery

Abstract

Obesity is an escalating public health concern and bariatric surgery remains the only effective long-term treatment for substantial weight reduction. However, bariatric surgery typically involves opioid use during and after the surgery, which can challenge recovery due to undesirable side effects. Although opioid-free anaesthesia (OFA) is a promising alternative, further research is needed to evaluate its safety and impact on long-term recovery, along with sustained opioid-free approaches for managing postoperative pain. The overall aim of this thesis was to evaluate the prerequisites and effects of an OFA pathway compared to conventional opioid-based care and to identify the prerequisites for integrating a person-centred care approach for patients undergoing laparoscopic bariatric surgery. The thesis includes a systematic review and meta- analysis (Study I), two qualitative interview studies with content analysis (Study II & IV), and a quantitative effect study (Study III). The thesis is based on a randomised controlled trial (RCT) in which the intervention included OFA and transcutaneous electrical nerve stimulation as primary postoperative pain management for patients undergoing laparoscopic bariatric surgery. Study II-IV are based on the same population from the RCT, conducted between May 2019 and November 2023. Study I established the prerequisites for an OFA pathway in various surgical contexts, including laparoscopic bariatric surgery. Meta-analysis results indicated reduced postoperative side effects and opioid consumption without compromising patient safety or pain management, compared with opioid-based anaesthesia. The RCT (Studies II-IV) supported the feasibility of the OFA pathway, with quantitative data revealing reduced opioid consumption and comparable pain and recovery outcomes up to 3 months. Qualitative findings revealed similar patient experiences during the perioperative and recovery periods for up to 1 year. Addressing perioperative challenges by integrating a person-centred care approach into the OFA pathway could improve patient outcomes. Overall, this thesis provides valuable insights to advance perioperative care, presenting a safe and viable alternative to conventional opioid-based perioperative approaches.