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Opioid free multimodal analgesia versus opioid based analgesia in bariatric surgery outcome

Background: Combined Opioid-free analgesia (OFA) and thoracic epidural (TE) by ultrasound is the technique that may have an enhanced recovery after surgery (ERAS), decrease perioperative opioid consumption and more improved positive outcomes than balanced general anesthesia with use of opioid after bariatric surgery. The Opioid free analgesia includes local anesthetics (Na channel blocker), alpha-2 receptor agonists (dexmetedomidine), NMDA antagonists (ketamine, lidocaine, magnesium sulfate), anti-inflammatory drugs (NSAID) and dexamethasone. Aim of the study: To evaluate the effect of opioid free analgesia with thoracic epidural as a multimodal analgesia versus balanced general analgesia on outcome of bariatric surgery on total opioid requirements, pain scores, and complications. Patients and Methods: The current study recruited sixty patients aged 20-50 years, ASA I, II, under bariatric surgery. 30 patients received OFA with Ultrasonic guided thoracic epidural with pre-induction by precedex, ketamine, xylocaine, esmolol, dexamethasone, paracetamol, and magnesium. Then propofol, and atracurium to insert (ETT), 30 patients received balanced general anesthesia (BGA), patients received fentanyl, propofol, atracurium. Results: There was significant decrease in pain scores within 24-hour postoperative pvalue < 0.05 and there was a clinically significant reduction in time for outcome from the recovery room for OFA & TE group. The number of satisfied was higher in the OFA& TE group (60%) than BGA group (30%) (p=0.037). Conclusion: Ultrasonic-guided TE block combined with Opioid free analgesia (OFA) is an option with a better ERAS pathway for pariatric surgery to decrease consumption of opioid perioperativly with no effect on recovery or pain control, better efficiency, and patient satisfaction.