Abstract
PURPOSE: Obese patients undergoing bariatric surgery face unique challenges in postoperative pain management and recovery. Due to altered opioid pharmacokinetics and heightened pain sensitivity in this population, optimizing analgesic regimens is crucial. This study compared the impact of oxycodone- vs sufentanil-based analgesic regimens on postoperative recovery quality in obese patients undergoing bariatric surgery. METHODS: Eighty-four obese patients (BMI ≥30 kg/m², ASA II-III) undergoing elective laparoscopic bariatric surgery were randomized into oxycodone (n=42) or sufentanil (n=42) groups. Standardized anesthesia included either oxycodone (0.3 mg/kg at induction, 0.1 mg/kg 10 min before surgery completion) or sufentanil (0.3 µg/kg at induction, 0.1 µg/kg 10 min before surgery completion). The primary outcome was the Quality of Recovery-40 (QoR-40) score at 24 h postoperatively. Secondary outcomes included NRS pain scores, rescue analgesia requirements, adverse events (PONV and hypoxemia), sedation scores, and recovery milestones. RESULTS: Compared to the sufentanil group, the oxycodone group had significantly higher 24-hour QoR-40 scores (median [IQR]: 187.0 [178.8-190.3] vs 173.0 [164.8-184.3]; estimated median difference: 11; 95% CI: 6-17; P<0.001), with improved physical comfort, emotional status, physical independence, and pain (all P<0.05). Oxycodone provided superior analgesia: lower NRS pain scores at 0.5, 2, 6, and 24 h postoperatively (all P≤0.003), reduced rescue analgesia in PACU (16.7% vs 50%; P=0.001) and on the ward (23.8% vs 64.3%; P<0.001), and fewer PACU adverse events-PONV (47.6% vs 69.1%; P=0.046), antiemetic use (14.3% vs 35.7%; P=0.023), and hypoxemia (19.1% vs 50%; P=0.003). Recovery milestones (extubation, first flatus, ambulation) occurred earlier in the oxycodone group (all P<0.05). CONCLUSION: Oxycodone significantly enhanced postoperative recovery quality compared with sufentanil in obese patients undergoing laparoscopic bariatric surgery, providing superior analgesia and reducing opioid-related side effects.