A new goal in opioid management in obese patients: Opioid-free anaesthesia

Opioids have unique features that facilitate premedication, smooth induction, ease the maintenance of anaesthesia and improve postoperative pain relief. However, they also have side effects such as respiratory depression, nausea and vomiting. Obesity is one of the most frequent disorders that require attentive opioids management. The physiological and pathophysiological consequences of opioids in obese population lead clinicians avoid or limit these drugs during anaesthetic management. The drugs used for an opioid-free anaesthesia plan include, but are not limited to, α-2 adrenergic receptor agonists, ketamine, lidocaine, gabapentinoids and magnesium, separately or in combinations. For opioid-free anaesthesia, clinicians should have thorough knowledge of pharmacokinetic and pharmacodynamic properties of substitute drugs used instead of opioids. Anaesthesia depth should be monitored. Minimally invasive surgery, experienced surgery and anaesthesia team help ensuring the success of this technique. Opioid-free anaesthesia is a new horizon for anaesthetists who try to perfect their practice in overweight patients. In this regard, opioid-free anaesthesia for obese population should be reserved for cautiously-selected patients and interventions.