Authors: Olausson, Alexander et al.
European Journal of Anaesthesiology 42(8): 714-726, August 2025. doi:10.1097/EJA.0000000000002193
This multicentre controlled trial compared a fully opioid-free care pathway—including intraoperative opioid-free anaesthesia (OFA) and postoperative first-line transcutaneous electrical nerve stimulation (TENS)—with conventional opioid-based care in patients undergoing laparoscopic bariatric surgery. A total of 110 patients were randomized equally to intervention or control groups.
The study found no significant differences in postoperative pain intensity between groups from PACU arrival to surgical ward discharge, nor at 24 hours, 72 hours, or 3 months postoperatively. However, patients in the opioid-free group had markedly lower opioid consumption both in the PACU and throughout their hospital stay. Postoperative quality of recovery scores were similar between groups during the 3-month follow-up.
Overall, an opioid-free care pathway provided equivalent pain and recovery outcomes while substantially reducing perioperative opioid requirements.
What you should know:
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Pain control and recovery were equivalent between opioid-free and opioid-based pathways.
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Opioid-free patients required significantly less opioid rescue medication in the PACU and hospital stay.
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No differences were observed in longer-term pain scores or quality of recovery.
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OFA with adjuncts such as TENS may safely minimize opioid exposure in bariatric surgery.
KEY POINTS
- The effects of an opioid-free care pathway that combines both pharmacological and nonpharmacological opioid-free interventions have not yet been studied.
- An opioid-free care pathway can provide comparable pain relief and quality of recovery outcomes with opioid-based standard treatment for up to 3 months after surgery, while significantly reducing the in-hospital opioid consumption.
- The novel approach of combining intraoperative opioid-free anaesthesia with postoperative transcutaneous electrical nerve stimulation (TENS) as first-line pain treatment has the potential to eliminate the use of perioperative opioids for patients undergoing bariatric surgery.
Thank you to the European Journal of Anaesthesiology for publishing this important trial on opioid-free perioperative care.