Equally effective pain relief without opioids in bariatric surgery

Opioid prescribing has increased, particularly in countries such as the United States, where the trend has been likened to an epidemic. Long-term use can lead to dependency and abuse. The opioid group of medicines is perhaps more commonly known as morphine and is effective in the short term against pain. However, opioids have side effects that can impair recovery after surgery. Opioids are currently the standard treatment for both treating pain impulses during surgery and relieving patients' pain after surgical procedures, including bariatric surgery.

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“Researchers agree that we need to reduce the use of opioids to promote recovery after bariatric surgery, but there has been a lack of knowledge about whether alternative treatment methods are really both safe and effective for the patient, especially for treating pain after surgery,” says Alexander Olausson, Nurse Anesthetist and PhD student at the Sahlgrenska Academy at the University of Gothenburg.

Safe and effective

The thesis is based on a randomized clinical study conducted at two hospitals in Sweden. In the study, 110 people scheduled for bariatric surgery received either the usual care with opioid medicines, or an alternative form of anesthesia and pain relief without opioids. The opioid-free treatment combines three different medicines that affect pain impulses via other signaling pathways than those used by opioids.

After surgery, the opioid-free treatment was supplemented with TENS (transcutaneous electrical nerve stimulation), where electrodes are attached to the skin and deliver weak electrical impulses to treat pain. If the alternative pain treatment were not effective enough, patients could get access to opioids.

“We see that the opioid-free care pathway is both safe and effective. The group of patients receiving the opioid-free treatment needed significantly less opioids during the treatment period, and in most cases they managed without them, while reporting no more pain than the group receiving the usual opioid treatment,” says Alexander Olausson.

Thesis: Prerequisites and effects of an opioid-free anaesthesia pathway in patients undergoing bariatric surgery.