Opioid-Free Anesthesia for Upper Limb Surgery in Obese Patients as a Day Case Surgery: A Prospective Observational Study

Background: Opioid-free anesthesia (OFA) is a relatively new approach, and many studies are still needed to assess its effectiveness and compare it to opioid-based anesthesia (OBA). Objectives: This study investigated the use of OFA in obese patients undergoing upper limb surgery and compares its outcomes with those of OBA. Methods: This prospective randomized clinical study included 76 obese patients with a Body Mass Index (BMI) ≥ 30 kg/m² who were scheduled for upper limb surgery. Patients were randomly assigned to receive either OFA (group A, n = 38) or OBA (group B, n = 38). The OBA group was administered propofol, fentanyl, and atracurium, while the OFA group received lidocaine, propofol, atracurium, and dexmedetomidine. All patients were mechanically ventilated, and anesthesia was maintained with isoflurane and atracurium. Primary outcomes monitored included postoperative pain [Visual Analog Scale (VAS) ≥ 4] and the number of rescue doses of tramadol. Secondary outcomes included extubation time, any cardiac events, hypoxia, postoperative nausea and vomiting (PONV), intensive care unit (ICU) admission rates, and duration of hospital stay. Results: The OFA group had significantly lower extubation time, mean arterial pressure (MAP), and heart rate (HR) compared to the OBA group. Additionally, VAS scores were significantly lower at the 30-minute and 2-hour marks after extubation (P < 0.001 and P < 0.001, respectively) in patients receiving OFA. The OFA group also experienced fewer adverse effects, required fewer rescue doses of tramadol, and had shorter hospital stays. Conclusions: Opioid-free anesthesia may result in better and safer outcomes for obese patients undergoing upper limb surgeries, with fewer postoperative complications and shorter hospital stays. However, further research is needed to fully understand the potential benefits of OFA compared to OBA.