ReviewAnesthesiology research and practice2026
Pharmacological Modulation of Perioperative Pain in Laparoscopic Bariatric Surgery: An Updated Evidence-Based Narrative Review of Intravenous Lidocaine, Dexmedetomidine, Opioid-Free and Opioid-Sparing Anesthesia, and ERAS-Based Protocols.
Review in Anesthesiology research and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Laparoscopic bariatric surgery is associated with specific analgesic challenges because opioid-related adverse effects may be especially relevant in patients with obesity, obstructive sleep apnea, and cardiometabolic comorbidities. Inadequate perioperative analgesia in this population may impair early mobilization and functional recovery, while excessive opioid use increases the risk of respiratory depression, postoperative nausea and vomiting (PONV), and prolonged hospital stay. This narrative review synthesizes and critically appraises contemporary evidence on intravenous lidocaine, dexmedetomidine, opioid-free or opioid-sparing anesthesia, and enhanced recovery after surgery (ERAS)-based perioperative strategies in adult patients undergoing laparoscopic bariatric surgery. A structured literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library from January 2018 to May 2026. A total of 41 studies were included, comprising randomized controlled trials, observational studies, pharmacokinetic investigations, systematic reviews, meta-analyses, and ERAS implementation studies. Methodological quality was appraised using RoB 2.0, ROBINS-I, and AMSTAR-2 according to study design. Evidence for intravenous lidocaine remains heterogeneous and appears dependent on dosing strategy, infusion duration, and perioperative context; its antiemetic and anti-inflammatory effects may be more consistent than its analgesic benefit when infusion is limited to the intraoperative period. Dexmedetomidine has been associated with reductions in perioperative opioid exposure and PONV through alpha-2-mediated sympatholysis and opioid-sparing mechanisms, although effects on pain scores are variable and hemodynamic monitoring is required. Opioid-free or opioid-sparing strategies may reduce opioid exposure and PONV, but superiority over conventional anesthesia for pain control or length of stay is inconsistent, and protocol heterogeneity limits generalizability. ERAS pathways represent the most comprehensive and evidence-supported framework for perioperative optimization, with benefit proportional to adherence and independent of any single pharmacologic agent. These pharmacologic strategies are best understood as mechanism-based adjuncts to be selectively integrated within high-adherence ERAS programs, not as universal standalone interventions. Rigorous multicenter randomized trials with standardized dosing, detailed ERAS adherence reporting, patient-centered outcome measures, and subgroup analyses by procedure type, OSA status, and PONV risk are needed.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.