Opioid-free total intravenous anesthesia resulted in similar rates of postoperative nausea and vomiting within 24 hours compared to opioid-free sevoflurane (64.7% vs 65.0%; P=1.000).
RCT (n=256)
randomized
No
Does opioid-free TIVA compared to opioid-free sevoflurane reduce postoperative nausea and vomiting in patients undergoing bariatric surgery?
Opioid-free TIVA and sevoflurane provide comparable anesthesia for bariatric surgery with similar rates of PONV, though TIVA is associated with modestly slower emergence.
Effect estimate: difference 0.4% points (95% CI -11.2 to 11.9)
Absolute Event Rate: 64.7% vs 65%
p-value: p=1.000
Background Opioid-free anesthesia (OFA) is increasingly used in bariatric surgery to prevent opioid-related adverse effects. Although both propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia with sevoflurane are compatible with OFA protocols, their relative opioid-free effectiveness is unclear. Methods In this single-center randomized controlled trial, 256 patients undergoing laparoscopic sleeve gastrectomy received either OFA with TIVA (propofol via Schnider TCI model) or OFA with sevoflurane. Both groups received identical nonopioid adjuncts (lidocaine, ketamine, dexmedetomidine). The primary outcome was the incidence of postoperative nausea and vomiting (PONV) within 24 h. Secondary outcomes included pain scores, opioid consumption, hemodynamic stability, and emergence characteristics. Results The primary endpoint, postoperative nausea and/or vomiting within 24 h, did not differ between groups and occurred in 80/123 patients (65.0%) in the Sevo group and 86/133 patients (64.7%) in the TIVA group (difference 0.4% points, 95% CI − 11.2 to 11.9; p = 1.000). Rates of postoperative nausea (65.0% vs. 63.2%; p = 0.855) and vomiting (25.2% vs. 26.3%; p = 0.952) were likewise similar. Postoperative pain scores and 24-hour opioid consumption were low and comparable. Hemodynamic events and rescue analgesic requirements were similar. However, prolonged emergence (> 10 min) was more frequent in the TIVA group than in the Sevo group (22.6% vs. 12.2%; difference 10.4% points, 95% CI 1.0 to 19.5; p = 0.044). Conclusion Opioid-free total intravenous anesthesia or opioid-free inhalational anesthesia with sevoflurane provide effective and safe anesthesia for bariatric surgery, with comparable pain control and opioid-sparing effects. High PONV incidence persists despite OFA, underscoring the need for enhanced prophylaxis. Emergence was modestly slower with TIVA, which may be related to known limitations of conventional target-controlled infusion models in patients with severe obesity and warrants further study. Trial Registration The study was registered at ClinicalTrials.gov (NCT06390046). The record was first posted on April 29, 2024 and the first participant was enrolled on April 30, 2024.
Maciejewski et al. (Mon,) conducted a rct in bariatric surgery (n=256). Opioid-free anesthesia with total intravenous anesthesia (TIVA) vs. Opioid-free anesthesia with sevoflurane was evaluated on incidence of postoperative nausea and vomiting (PONV) within 24 h (difference 0.4% points, 95% CI -11.2 to 11.9, p=1.000). Opioid-free total intravenous anesthesia resulted in similar rates of postoperative nausea and vomiting within 24 hours compared to opioid-free sevoflurane (64.7% vs 65.0%; P=1.000).