Opioid-free versus opioid-based anesthesia for obese patients: Systematic Review and meta-analysis
Description
Anesthesia with opioids has many side effects. Currently, opioid-free anesthesia (OFA) is feasible and safe. We hypothesize that reducing the exposure of obese patients to opioids during anesthesia can enhance recovery after surgery since it could minimize opioid-related side effects during the postoperative period. A systematic review and meta-analysis were managed to evaluate OFA for obese patients. We developed a sensitive search strategy aiming to include randomized controlled trials (RCTs) with no language restrictions where any regional anesthesia was associated with general anesthesia. Any drug was given before surgery to treat unintended anesthesia side effects. PubMed, Embase, Cochrane library databases, ClinicalTrials.gov, and gray literature databases were systematically searched up to 07/31/2020. The following search terms were used: analgesics, opioid [pharmacological action] or analgesics, opioid or analgesics and opioid or opioid analgesics or opioid and free and anesthesia or anesthesia or anesthesia and obesity or obesity or obese and humans regarding postoperative complications.
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We developed a sensitive search strategy to include randomized controlled trials (RCTs) with no language restrictions where any regional anesthesia was associated with general anesthesia. Any drug was given before surgery to treat unintended anesthesia side effects. PubMed, Embase, Cochrane library databases, ClinicalTrials.gov, and gray literature databases were systematically searched up to 07/31/2020. The following search terms were used: analgesics, opioid [pharmacological action] or analgesics, opioid or analgesics and opioid or opioid analgesics or opioid and free and anesthesia or anesthesia or anesthesia and obesity or obesity or obese and humans regarding postoperative complications. The reference lists of all retrieved articles were reviewed to identify additional articles missed using these search terms. The authors approved all the enrolled studies. 2.2. Inclusion criteria Studies meeting the following criteria were included: 1. population: obese patients (BMI > 30 kg/m2), older than 18 years old; 2. intervention: general opioid-free anesthesia (OFA) for elective surgery; 3. comparison: opioid-based anesthesia; 4. outcome: recovery from anesthesia, pain in the postoperative period, length to discharge from the PACU and hospital stay, mortality, respiratory depression, paralytic ileus, urinary retention, postoperative nausea and vomiting (PONV); 5. design: RCTs. 2.3. Exclusion criteria The exclusion criteria were: 1. reviews, nonclinical studies, and case observations; 2. non-RCTs; 3. reduplicated studies; 4. studies in which opioid-free group receive opioid in perioperative time; 5. improper outcome measures; 6. patients with atrioventricular block, intraventricular or sinoatrial block, Adam-Stokes syndrome, patients treated with β-blockers and HR <50 bpm, or cardiac insufficiency with a left ventricular ejection fraction (LVEF) <40%; pregnant or breastfeeding women; 7. a meta-analysis, case reports, editorials, and meeting abstracts.