Piotr Mieszczański

Obese patients undergoing bariatric surgery are particularly susceptible to increased postoperative pain and opioid-related adverse effects. Enhancing patient safety and comfort may include the reduction of opioid requirements by the use of co-analgesics such as pregabalin. The aim of our study was to evaluate its safety and efficacy in patients undergoing laparoscopic sleeve gastrectomy (LSG). This double-blind, randomized controlled trial involved 90 patients who were assigned to receive either pre-operative pregabalin 150 mg or a placebo. The primary outcome was total oxycodone consumption within the first 24 h. We also assessed pain scores, incidence of nausea and vomiting, pregabalin-related side effects, hemodynamic parameters, and recovery at predefined time points. The pregabalin group had a similar total oxycodone consumption compared to the placebo. Concerning pain assessment, the study group had a lower score at the 6th hour, 2.16 vs. 2.64 ( p = 0.047). No differences were found in the other outcomes. Pre-emptive 150 mg pregabalin before LSG was well tolerated, yet did not significantly reduce total oxycodone consumption. Moreover, the observed differences between groups at specific time points do not support the routine use of pregabalin until further research demonstrates clinically significant benefits.

Background: Chronic post-surgical pain (CPSP) is a phenomenon that negatively influences patients’ quality of life and well-being. By definition, CPSP is a pain in the surgical area of injury that develops or increases after the operation and persists beyond the healing process. One of the populations that is especially vulnerable to CPSP is patients undergoing bariatric surgery, as obesity, chronic inflammation, pre-existing chronic pain, and severe postoperative pain are its risk factors. Therefore, we conducted a cross-sectional study assessing the prevalence of CPSP in patients undergoing laparoscopic sleeve gastrectomy (LSG). We also aimed to explore the potential influence of the promising opioid-free anesthesia (OFA) technique, assess if the CPSP after LSG had a potential neuropathic component, and additionally, determine whether the bariatric surgery altered chronic pain in this patient population. Methods: The study was registered on 11 November 2024, at ClinicalTrials.gov (NCT06686875). A cross-sectional study using e-survey.io was conducted among the patients who underwent LSG 3 months to 5 years earlier. Clinical data were retrieved from the hospital database. Results: Of the 135 patients who responded to our e-survey, 4.4% (n = 6, 95% CI 0.9–8%) reported CPSP. None of them had a PAIN DETECT score above 19, which would indicate a neuropathic component. Of the 32 patients who had pre-existing chronic pain, 31 reported a reduction in its intensity, and of the 16 patients on chronic opioid treatment, 10 discontinued opioid therapy. In a subgroup analysis, there was no significant difference in the prevalence of CPSP and long-term opioid therapy between the patients who had OFA and standard anesthesia (p > 0.05). Conclusions: The main finding of our study is that a minor, yet significant, portion of patients who underwent LSG develop CPSP, and OFA does not alter the risk. LSG appears to reduce pre-existing chronic pain and opioid use.

Background and Objective: Postoperative nausea and vomiting (PONV) ranks among the most common postoperative complications, affecting up to 80% of patients undergoing laparoscopic bariatric surgery. This condition negatively impacts patient comfort and well-being while also potentially delaying ambulation and increasing the risk of anastomotic and wound dehiscence. Although various interventions can mitigate the risk of PONV, none are entirely effective; therefore, combined prophylactic strategies are the standard approach. In recent years, numerous techniques and interventions have emerged; consequently, this scoping review aims to assess the current evidence regarding PONV prevention in patients undergoing laparoscopic bariatric procedures. Methods: This review was conducted in accordance with PRISMA guidelines and registered with OSF. A search was performed across the MEDLINE (PubMed), Scopus, Embase, and Web of Science databases. Inclusion criteria encompassed randomized controlled trials (RCTs) published up to May 2025, focusing on adult patients undergoing laparoscopic bariatric surgeries with PONV as a primary or secondary outcome. Results: A total of 81 studies were included in this review, encompassing a broad range of perioperative techniques, including opioid-sparing adjuvants, regional anesthesia, and pharmacological interventions. Conclusions: While there is general consensus and guidance advocating for a multimodal approach to PONV prevention, debates persist regarding the optimal techniques and antiemetic drug regimens to implement. Emerging evidence, particularly concerning regional anesthesia strategies and combined pharmacological prophylaxis, including novel agents, highlights the potential advantages of innovative approaches. Highlights: Effective management of postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery is essential, given its impact on patient comfort, recovery, and the potential to prevent wound or anastomotic dehiscence. Although multimodal antiemetic strategies are regarded as standard, disagreements remain regarding specific measures to be adopted. New techniques and strategies, including advanced regional anesthesia techniques, pharmacological, and non-pharmacological methods, offer promising avenues for improved prophylaxis.

Introduction: Neuropathic pain (NP) arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. Antidepressants (ADs) are recommended for the pharmacological treatment of NP. However, current guidelines do not specify how long ADs may be effective in NP treatment if the patient is benefiting from the therapy.Material and methods: This was a retrospective cross-sectional study aiming to analyze the effectiveness of ADs in the treatment of NP by assessing the relationship between AD usage, the length of AD treatment and the intensity of pain in this group patients. Based on their pain intensity and length of treatment, the patients were divided into: three groups (NRS 0–3, NRS 4–6 and NRS ≥ 7), and six groups (< 1 month, 1–3 months, 3–6 months, 6–12 months, 1–2 years, 2–5 years, and > 5 years), respectively.Results: The study was conducted on a database from 421 patients, 231 (54.86%) of whom took antidepressants. We found that AD treatment significantly reduces the likelihood of being in the NRS 7–10 group compared to the NRS 0–3 group (OR = 0.611, 95% CI: 0.37–1.0, P = 0.05), and this reduction was observed up to 24 months of treatment (OR = 0.41, 95% CI: 0.22–0.75, P < 0.004).Conclusions: Considering the limitations of the study, the use of ADs in NP therapy may have a significant impact on reducing the occurrence of severe pain up to 24 months of therapy and should be included in pharmacotherapy in this group of patients.

Background: Obese patients undergoing laparoscopic sleeve gastrectomy (LSG) are particularly at risk of opioid-related side effects. To reduce patient exposure to opioids, multimodal analgesia, which involves the use of drugs of different classes, may be utilized. One of the drugs under consideration is pregabalin. Despite an opioid-sparing potential, few studies assess the role of pregabalin as an element of multimodal analgesia in LSG. Considering the limited number and inconsistent results of available studies, we decided to conduct a randomized, prospective study on the effect of preemptive pregabalin administration in obese patients on opioid consumption, pain scores, the incidence of opioid side effects, and hemodynamical stability. Methods: The study is designed as a prospective randomized controlled trial with double-blinding. Randomization will be performed in a block with a parallel 1:1 allocation. The intervention will involve receiving a pregabalin 150 mg capsule 1–2 h before the surgery, whereas the control group will receive an identically looking placebo. The primary outcome measure will be total oxycodone consumption in the first 24 h following surgery. Secondary outcome measures will be pain severity assessed using the Numerical Rating Scale (NRS) 1, 6, 12, and 24 h after surgery, postoperative sedation on the Ramsay scale, PONV impact scale, the incidence of desaturation episodes < 94%, and episodes of blurred vision at 1, 6, 12, and 24 h after surgery, intraoperative hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total fluid volume, and total ephedrine dose. Patient comfort will be additionally assessed using the QoR-40 questionnaire at discharge. Discussion: The study will explore the efficacy and safety of preemptive pregabalin in a dose of 150 mg as a co-analgesic used in multimodal analgesia for LSG. As studies on opioid-sparing regimes concern the safety of obese patients, we aim to contribute objective data with a relatively large study sample size. The result of the present clinical trial may support the reassessment of recommendations to use pregabalin in the studied population. Trial registration: ClinicalTrials.gov NCT05804591. Registered on 07.04.2023.

Opioid-free anesthesia (OFA) is a heterogeneous group of general anesthesia techniques in which the intraoperative use of opioids is eliminated. This strategy aims to decrease the risk of complications and improve the patient’s safety and comfort. Such potential advantages are particularly beneficial for selected groups of patients, among them obese patients undergoing laparoscopic bariatric surgery. Opioids have been traditionally used as an element of balanced anesthesia, and replacing them requires using a combination of coanalgesics and various types of local and regional anesthesia, which also have their side effects, limitations, and potential disadvantages. Moreover, despite the growing amount of evidence, the empirical data on the superiority of OFA compared to standard anesthesia with multimodal analgesia are contradictory, and potential benefits in many studies are being questioned. Additionally, little is known about the long-term sequelae of such a strategy. Considering the above-mentioned issues, this study aims to present the potential benefits, risks, and difficulties of implementing OFA in bariatric surgery, considering the current state of knowledge and literature.

BACKGROUND Patients with obesity with interstitial lung diseases (ILD) are encouraged to lose weight, as it improves lung function and lung transplant eligibility. As exercise tolerance in these patients is low and weight gain is a common adverse effect of corticosteroids, bariatric surgery can be an effective method for the management of obesity in this patient group. However, perioperative complications in such high-risk patients remain a concern. Therefore, we aimed to demonstrate successful anesthetic management for obese patients with ILD, which may be practically utilized to reduce perioperative pulmonary complications and improve outcomes. CASE REPORT Our case report presents a 42-year-old man with ILD who underwent laparoscopic sleeve gastrectomy (LSG). Preoperative studies revealed severe restrictive disease, right ventricular overload with assessed intermediate risk of pulmonary hypertension, and heart failure, with preserved left ventricle fraction but with poor exercise tolerance. Patient had opioid-free anesthesia (OFA) and postoperative multimodal analgesia. Following a 24-h stay in the Post-Anesthesia Care Unit, the patient was transferred to the ward and ultimately discharged home 2 days thereafter. At the 1-year follow-up, the patient reduced his weight by 40 kg and reported a significant improvement in physical capacity. CONCLUSIONS Our record demonstrates that OFA can be successfully used in high-risk patients with ILD undergoing LSG. In a period of a year, the patient improved so much that he no longer required lung transplantation, which may encourage clinicians to provide bariatric surgery using the OFA technique in the population of patients with obesity and severe respiratory illness.

Anesthesia for laparoscopic sleeve gastrectomy and perioperative management remains a challenge. Several clinical studies indicate that opioid-free anesthesia (OFA) may be beneficial, but there is no consensus on the most optimal anesthesia technique in clinical practice. The aim of our study was to assess the potential benefits and risks of intraoperative OFA compared to multimodal analgesia (MMA) with remifentanil infusion. In a prospective, randomized study, we analyzed 59 patients’ data. Primary outcome measures were oxycodone consumption and reported pain scores (numerical rating scale, NRS) at 1, 6, 12, and 24th hours after surgery. Postoperative sedation on the Ramsay scale, nausea and vomiting on the PONV impact scale, desaturation episodes, pruritus, hemodynamic parameters, and hospital stay duration were also documented and compared. There were no significant differences in NRS scores or total 24-h oxycodone requirements. In the first postoperative hour, OFA group patients needed an average of 4.6 mg of oxycodone while the MMA group 7.72 mg (p = 0.008, p < 0.05 statistically significant). The PONV impact scale was significantly lower in the OFA group only in the first hour after the operation (p = 0.006). Patients in the OFA group required higher doses of ephedrine 23.67 versus 15.69 mg (p = 0.039) and more intravenous fluids 1160 versus 925.86 ml (p = 0.007). The mode of anesthesia did not affect the pain scores or the total dose of oxycodone in the first 24 postoperative hours. Only in the first postoperative hour were an opioid-sparing effect and reduction of PONV incidence seen in the OFA group when compared with remifentanil-based anesthesia. However, patients in the OFA group showed significantly greater hemodynamic lability necessitating higher vasopressor doses and more fluid volume.