Effects of an Opioid Free/Sparing Care Pathway for Patients Undergoing Obesity Surgery

Summary

The opioid consumption has exploded in the western world, and for some patient populations such as obese patients, patients with sleep apnoea or patients undergoing cancer treatment, opioid-sparing/ opioid-free strategies could have positive effects on outcomes. Studies suggest that opioids could have opioid-induced immunosuppression, induce chronic post-operative pain syndrome and hyperalgesia in addition to the more well-known side effects such as respiratory depression, nausea, bladder, and bowel dysfunction. Hence, new studies are needed on the impact of person-centered care programs that combine pharmaceutical and non-pharmaceutical strategies to reduce the adverse short and long-term effects of opioid therapy. The overall aim is to evaluate the short-, medium- and long-term effects of opioid-free care pathways with or without person-centred care compared to conventional opioid-based treatment in patients undergoing obesity surgery. Specific aims 1. Determine the effects of opioid-free care with or without person-centred care compared with conventional opioid-based general anaesthesia on the cognitive and physical quality of recovery after surgery up to 24 months after surgery (short-term: postoperative to discharge, medium-term: 14 days, 3 months, long-term: 6 months, 12 months and 24 months). 2. Describe the clinical monitoring trend regarding nociceptive response intraoperatively between opioid-free and conventional care. 3. Map the impact of opioid-free anaesthesia (with and without person-centred care) on the usage of opioids up to 24 months after hospital discharge. 4. Explore the patients' experience of quality of life, economic evaluations, self-efficacy and recovery after surgery in opioid-free care with or without person-centred care during the first year post-surgery. The aims will be evaluated by a prospective, randomized, non-blinded, non-commercial multi-centre study (Nov 2018-Dec 2022) approved by the Swedish Medicines Agency (EU-CT 2023-505934-86-00) and the ethical review board (DNR 1006-17).

Timeline

Start

2019-05-01

Primary completion

2028-05-31

Completion

2029-12-31

Publications

• Widarsson Norbeck D, Ohrstrom H, Lindgren S, Wolf A, Jildenstal P. Linking intraoperative nociception to postoperative pain: a secondary comparative analysis of opioid-free and opioid-based anesthesia. Scand J Pain. 2026 Mar 11;26(1). doi: 10.1515/sjpain-2025-0063. eCollection 2026 Jan 1.
• Olausson A, Jildenstal P, Andrell P, Angelini E, Stenberg E, Wallenius V, Ohrstrom H, Thorn SE, Wolf A. Effects of an opioid-free care pathway vs. opioid-based standard care on postoperative pain and postoperative quality of recovery after laparoscopic bariatric surgery: A multicentre randomised controlled trial. Eur J Anaesthesiol. 2025 Aug 1;42(8):714-726. doi: 10.1097/EJA.0000000000002193. Epub 2025 May 14.

Drugs

Indications