The Effect of an Opioid-free Anesthetic on Post-operative Opioid Consumption After Laparoscopic Bariatric Surgery: a Prospective, Single-blinded, Randomized Controlled Trial

Active_comparator: Control Goup A- Opioid-based regimen

Preop - Multimodals unless contraindicated~Induction~* Fentanyl (50mcg IV)~* Lidocaine 1.5mg/kg IV bolus using IBW (Ideal body weight)~* Propofol 2-3mg/kg IV bolus~* Neuromuscular blockade per Anesthesiology team discretion~Maintenance~* Sevoflurane~* Neuromuscular blockade at discretion of anesthesiology team~* May use fentanyl to treat SBP or HR \> 20% of baseline~Emergence~* Neuromuscular reversal, dosed according to Virginia Mason protocol~* May titrate fentanyl per anesthesiology team throughout the case.~* Patient extubated and brought to PACU~PACU opioid orders per anesthesiology team~Post-operative Nausea/Vomiting Prophylaxis~-4mg dexamethasone, 1mg haloperidol, scopolamine patch

Experimental: Experimental Group B- Opioid-free regimen

Preop - Multimodals unless contraindicated~Induction~* Dexmedetomidine 1mcg/kg IV bolus over 10 minutes using IBW~* Lidocaine 1.5mg/kg IV bolus using IBW~* Propofol 2-3mg/kg IV bolus~* Neuromuscular blockade per Anesthesiology team discretion~* Ketamine 0.5mg/kg IV bolus (based on IBW)~Maintenance~* Sevoflurane~* Dexmedetomidine 0.4 mcg/kg/hr IV infusion using IBW (may titrate based on patient response between 0.3-0.5mcg/kg/hr)~* Lidocaine 2mg/kg/hr IV infusion using IBW~* May use esmolol as needed to treat SBP or HR \> 20% of baseline~* Neuromuscular blockade at the discretion of anesthesiology team~Emergence~* Dexmedetomidine infusion turned off during laparoscopic desufflation~* Lidocaine infusion turned off at skin closure~* Neuromuscular reversal, dosed according to VM protocol~* Pt extubated and brought to PACU~* PACU opioid orders per anesthesiology team~Post-operative Nausea/Vomiting Prophylaxis~-4mg dexamethasone, 1mg haloperidol, scopolamine patch