Opioid free technique enhances safety in patients with morbid obesity and obstructive sleep apnea, undergoing non -bariatric surgery : a double blind randomised controlled study

Opioids have been known to potentiate airway related adverse events related to sleep-disordered breathing in all patients, moreso, in the patients with morbid obesity. There is progressively large number of surgical patients with obesity and obstructive sleep apnea requiring not just bariatric but also non-bariatric surgery.

There are increasing reports of post operative adverse events in them.particularly  high risk of airway related adverse events (ARAE: risk of obstructed breathing, increased sedation and hypersomnolence) in the postoperative period. Furthermore, opioids are likely to put hurdle by increasing nausea, vomiting, respiratory depression, delayed emergence with hypoventilation , muscle fatigue , ileus and urinary retention to name a few. [4].

This remains a major deterrent while considering them for general anesthesia or ambulatory surgery. Though laparoscopic surgeries under ERAS (enhanced recovery after surgery) represents the best possible patient safety and quality improvement program, there remains a caveat with respect to use of opioids.

Anaesthetic considerations in ERAS have been well established including the multimodal analgesic approach, there remains speculation that opioid-free anaesthesia may offer additional benefit to achieve the goals of ERAS moreso, for this vulnerable group of patients. This remains main reason for considering use of opioid-free anesthesia techniques in them..

The concept of OFA (opioid free analgesia) techniques in the era of evidence- based medicine has emerged as a feasible safe option.  There is paucity of well structured studies to support the concept of OFA in this population.