Opioid-free anesthesia vs Opioid-based anesthesia

Opioid-free anesthesia vs Opioid-based anesthesia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Opioid-free anesthesia vs Opioid-based anesthesia 1. Emanuel J. Almeida, 2. Fabio M. Almeida, Carina Rossoni, Rui Ribeiro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8269644/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Bariatric surgery is considered the most effective treatment for morbid obesity, but perioperative pain control and the prevention of postoperative nausea and vomiting (PONV) remain major clinical challenges. Traditional opioid-based anesthesia (OBA) is effective for antinociception but associated with adverse effects, prompting increasing interest in opioid-free anesthesia (OFA). Methods In this prospective, randomized study, 60 patients undergoing laparoscopic bariatric surgery were allocated to receive either OBA (desflurane + remifentanil, with postoperative multimodal analgesia including morphine) or OFA (desflurane + dexmedetomidine, lidocaine, ketamine, and opioid-free multimodal postoperative analgesia). Primary outcomes included postoperative pain (Numerical Rating Scale, NRS) and need for rescue analgesia. Secondary outcomes were intraoperative nociception (NOL index), incidence of PONV, and patient satisfaction. Results The OFA group showed significantly lower pain scores at PACU discharge (p = 0.004), within the first 24 hours (p = 0.035), and at hospital discharge (p = 0.023), as well as a reduced need for rescue analgesia (p = 0.002). NOL monitoring suggested improved intraoperative nociception control with OFA. No significant differences were found in PONV incidence between groups. Patient satisfaction was high in both groups, with a non-significant trend favoring OFA. No major perioperative complications were observed. Conclusions Opioid-free anesthesia demonstrated superiority over opioid-based techniques in reducing postoperative pain and rescue analgesia requirements in bariatric surgery, without increasing adverse events. These findings support OFA as a safe and effective strategy, warranting larger multicenter trials to validate its clinical benefits and long-term impact. Trial registration: NCT Number: NCT07337135. Registered on 13th January 2026. Retrospectively registered. morbid obesity anesthesia opioids bariatric surgery metabolic surgery postoperative pain PONV Figures Figure 1 Figure 2 Introduction Obesity is a chronic disease affecting approximately 890 million people worldwide¹ and is associated with a range of serious comorbidities, including type 2 diabetes mellitus (T2DM), hypertension (HTN), obstructive sleep apnea syndrome (OSAS) and obesity hypoventilation syndrome (OHS) and metabolic syndrome. The latter is defined by the presence of three of the following five criteria: waist circumference > 102 cm (men) or > 88 cm (women); triglycerides > 150 mg/dL; HDL cholesterol < 40 mg/dL (men) or 100 mg/dL.¹ Bariatric surgery is widely recognized as the most effective intervention for sustained weight loss, control of obesity-related comorbidities, and improvement in life expectancy in severe cases. 2 – 5 Approximately 600,000 patients undergo bariatric surgery annually, with an even larger population meeting criteria for the procedure.² The most commonly reported perioperative complications include deep vein thrombosis (DVT) / pulmonary embolism (PE), anastomotic leak, respiratory failure, hemorrhage, and surgical site infection.³ In high-volume reference centers, bariatric surgery carries a 30-day mortality rate of 0.5% and a morbidity rate of 5%.³ Over recent years, the Enhanced Recovery After Surgery (ERAS) program has gained worldwide adoption across multiple surgical specialties. This program — consisting of a series of evidence-based, multidisciplinary perioperative interventions primarily aimed at improving postoperative recovery — has been shown to reduce morbidity, hospital length of stay, and associated costs, while increasing patient satisfaction.⁵ The first ERAS guidelines for perioperative management in bariatric surgery were published in 2016 and later updated in 2021 to reflect evolving evidence.⁵ Despite these updates, current scientific evidence still does not allow the recommendation of a specific anesthetic technique or specific anesthetic agents. However, there is consensus that the use of drugs that are rapidly reversible and fast-acting, while minimizing opioid exposure, contributes to improved postoperative recovery.⁵ In opioid-based anesthesia (OBA)—traditionally used to achieve antinociception—remifentanil is the drug of choice. Nevertheless, rapid tolerance to opioids, along with a well-known profile of postoperative adverse effects (nausea and vomiting, respiratory depression, prolonged sedation, urinary retention, ileus, postoperative hyperalgesia, and chronic pain)⁶, may prolong hospitalization or even result in unplanned readmissions. Recently, there has been a growing shift toward opioid-free anesthesia (OFA), focusing on the use of adjuvant drugs (lidocaine, dexmedetomidine, ketamine, etc.) and regional anesthesia to achieve hypnosis, amnesia, and hemodynamic stability, while avoiding the adverse effects associated with opioids. This approach has demonstrated a more favorable profile, contributing to earlier return of bowel motility, reduced postoperative hyperalgesia, and lower incidence of postoperative nausea and vomiting (PONV).⁵ Given these considerations, the objective of this study was to compare the efficacy and safety of opioid-based anesthesia (OBA) versus opioid-free anesthesia (OFA) in patients undergoing laparoscopic bariatric surgery. We hypothesized that the OFA technique would result in improved pain control, lower incidence of PONV, and greater overall patient satisfaction. Methods This was a prospective study including 60 individuals undergoing laparoscopic bariatric surgery. Inclusion criteria were: age ≥ 18 years; body mass index (BMI) ≥ 35 kg/m² with associated comorbidities, or BMI ≥ 40 kg/m². Exclusion criteria were: pregnancy, history of substance abuse, or severe psychiatric disease. No formal sample size calculation was performed. The sample size was determined pragmatically based on the number of eligible patients undergoing bariatric surgery during the study period. Participants were randomly allocated using a computerized system to ensure random distribution into two groups (Fig. 1 ): OBA Group — opioid-based anesthesia (n = 30); OFA Group — opioid-free anesthesia (n = 30). Each participant underwent an anesthetic intervention according to the respective protocol (Table 1 ): Table 1 Anesthetic Protocols OBA group OFA group Standard monitoring + BIS + TOF + NOL Venous catheterization and initiation of goal-directed fluid therapy with balanced crystalloid Start of remifentanil infusion (2 mg / 40 mL saline) Induction with propofol Neuromuscular blockade with rocuronium Maintenance with desflurane PONV prophylaxis with dexamethasone 4–8 mg after induction Antibiotic prophylaxis with cefazolin 2–4 g Stress-ulcer prophylaxis with esomeprazole 40 mg Postoperative analgesia: paracetamol + ketorolac/parecoxib + metamizole Administration of ondansetron 4 mg and droperidol 0.625 mg 30 minutes before the end of surgery Termination of remifentanil infusion at the end of surgery Reversal of neuromuscular blockade with sugammadex Rescue analgesia in PACU with tramadol 100 mg and/or morphine PONV treatment in PACU with ondansetron 4 mg Standard monitoring + BIS + TOF + NOL Venous catheterization and initiation of goal-directed fluid therapy with balanced crystalloid Bolus of dexmedetomidine 15–20 µg followed by infusion: dexmedetomidine 50 µg + ketamine 50 mg + lidocaine 500 mg in 50 mL saline (rate: 1 mL / 10 kg total body weight) Induction with propofol Neuromuscular blockade with rocuronium Maintenance with desflurane PONV prophylaxis with dexamethasone 4–8 mg after induction Antibiotic prophylaxis with cefazolin 2–4 g Stress-ulcer prophylaxis with esomeprazole 40 mg Postoperative analgesia: paracetamol + ketorolac/parecoxib + metamizole Infusion rate reduced by half 30 minutes before the end of surgery (continued for 1 hour in PACU, until completion or discharge) Reversal of neuromuscular blockade with sugammadex Rescue analgesia in PACU with tramadol 100 mg PONV treatment in PACU with ondansetron 4 mg Variables: Demographic variables Age Sex Anthropometric and clinical variables Weight, height, BMI Comorbidities (HTN, T2DM, OSAS/OHS) Regular medication (β-blockers, antihypertensives, statins, glucocorticoids, synthetic opioids, antidepressants, others) Alcohol and tobacco use Surgical variables Procedure performed Surgical duration Intraoperative and postoperative complications Length of hospital stay Anesthetic variables Intraoperative analgesia (Nociception Level Index – NOL, Medasense®) Postoperative pain (Numerical Rating Scale, NRS) assessed: upon PACU arrival at PACU discharge within first 24 postoperative hours at hospital discharge Need for rescue analgesia (with or without opioids) Incidence of PONV and need for treatment PONV Impact Scale Score at 6 and 24 hours postoperatively Biochemical variables Hemoglobin, leukocytes, C-reactive protein (CRP), procalcitonin, erythrocyte sedimentation rate (ESR) Patient satisfaction Assessed using a 1–10 scale (1 = not at all satisfied; 10 = very satisfied) Quantitative variables were described as mean ± standard deviation or median and interquartile range, depending on distribution (assessed via the Shapiro–Wilk test). Categorical variables were expressed as absolute and relative frequencies. Means were compared using the Student’s t-test; for non-parametric distributions, the Mann–Whitney test was used. Proportions were compared using Pearson’s chi-square test or Fisher’s exact test. To control for confounders, a generalized linear model (GLM) with Bonferroni correction was applied: Tweedie model with log link → asymmetric variables; Linear model → symmetric variables; Binary logistic model → dichotomous variables. The significance level was set at p < 0.05. All analyses were performed using SPSS version 28.0. Results The study population (n = 60) was predominantly female (76.7%), with a mean age of 44.9 ± 10.6 years and a mean BMI of 39.1 ± 5.0 kg/m². The most prevalent comorbidity was hypertension (36.7%), followed by dyslipidemia and depressive syndrome. Table 1 summarizes the demographic and clinical characteristics of the participants. Table 1 Demographic and Clinical Characteristics of Participants (n = 60) Characteristics* Total Sample n = 60 (100%) OFA n = 30 (50%) OBA n = 30 (50%) p Age (years) 44,9 ± 10,6 47,2 ± 10,3 42,7 ± 10,5 0,102 Biological Sex 0,760 Male 14 (23,3) 8 (26,7) 6 (20,0) Female 46 (76,7) 22 (73,3) 24 (80,0) Alcohol consumption 0,302 None 29 (48,3) 17 (56,7) 12 (40,0) Occasional 30 (50,0) 13 (43,3) 17 (56,7) Regular 1 (1,7) 0 (0,0) 1 (3,3) Smoking 12 (20,0) 5 (16,7) 7 (23,3) 0,747 Anthropometrics Weight (kg) 109,1 ± 18,9 110,5 ± 20,1 107,8 ± 17,9 0,596 Height (m) 1,67 ± 0,07 1,67 ± 0,08 1,66 ± 0,06 0,375 BMI (kg∕m 2 ) 39,1 ± 5,0 39,3 ± 5,0 39,0 ± 5,0 0,815 Comorbidities 44 (73,3) 22 (73,3) 22 (73,3) 1,000 Hypertension 22 (36,7) 13 (43,3) 9 (30,0) 0,422 Dyslipidemia 20 (33,3) 12 (40,0) 8 (26,7) 0,411 Type 2 Diabetes 7 (11,7) 4 (13,3) 3 (10,0) 1,000 OSAS/OHS 13 (21,7) 7 (23,3) 6 (20,0) 1,000 Metabolic Syndrome Asthma 1 (1,7) 3 (5,0) 0 (0,0) 1 (3,3) 1 (3,3) 2 (6,7) 1,000 1,000 GERD/Gastritis 6 (10,0) 1 (3,3) 5 (16,7) 0,195 Depression 19 (31,7) 13 (43,3) 6 (20,0) 0,096 Fibromyalgia 1 (1,7) 0 (0,0) 1 (3,3) 1,000 Hipothyroidism 8 (13,3) 3 (10,0) 5 (16,7) 0,706 Epilepsy Chronic medication β-blockers Other anti-hypertensives Statins Glucocorticoids Antidepressives Oral Antidiabetics Bronchodilators Anticonvulsants Levothyroxine 2 (3,3) 39 (65,0) 7 (11,7) 14 (23,3) 17 (28,3) 1 (1,7) 21 (35,0) 6 (10,0) 4 (6,7) 2 (3,3) 8 (13,3) 0 (0,0) 21 (70,0) 4 (13,3) 8 (26,7) 11 (36,7) 0 (0,0) 15 (50,0) 4 (13,3) 1 (3,3) 0 (0,0) 3 (10,0) 2 (6,7) 18 (60,0) 3 (10,0) 6 (20,0) 6 (20,0) 1 (3,3) 6 (20,0) 2 (6,7) 3 (10,0) 2 (6,7) 5 (16,7) 0,492 0,588 1,000 0,760 0,252 1,000 0,030 0,671 0,612 0,492 0,706 *values expressed as mean ± SD or n (%), as appropriate At the 15-minute measurement point, the NOL index was significantly higher in the OBA group (p = 0.041). At other time points, lower NOL values were generally more frequent in the OFA group, though without statistical significance. (Table 2 ). Table 2 NOL Index Comparison Between OFA and OBA (n = 60) Variables* Total sample n = 60 (100%) OFA n = 30 (50%) OBA n = 30 (50%) P NOL Measurement Availability Measured Not Measured 25 (41,7) 35 (58,3) 13 (43,3) 17 (56,7) 12 (40,0) 18 (60,0) 1,000 NOL Index 15 min 25 (100) 13 (100) 12 (100) - 30 min 25 (100) 13 (100) 12 (100) - 45 min 25 (100) 13 (100) 12 (100) - 60 min 24 (96,0) 13 (100) 11 (91,7) 0,480 75 min 23 (92,0) 13 (100) 10 (83,3) 0,220 90 min 20 (80,0) 11 (84,6) 9 (75,0) 0,645 105 min 15 (60,0) 8 (61,5) 7 (58,3) 1,000 120 min 14 (56,0) 8 (61,5) 6 (50,0) 0,859 135 min 10 (41,7) 7 (53,8) 3 (27,3) 0,240 150 min 3 (12,0) 1 (7,7) 2 (16,7) 0,593 165 min 2 (8,0) 1 (7,7) 1 (8,3) 1,000 180 min 2 (8,0) 1 (7,7) 1 (8,3) 1,000 NOL Index 15 min 0,041 < 10 16 (64,0) 11 (84,6) 5 (41,7) 10–25 9 (36,0) 2 (15,4) 7 (58,3) NOL Index 30 min 0,056 < 10 18 (72,0) 12 (92,3) 6 (50,0) 10–25 5 (20,0) 1 (7,7) 4 (33,3) 26–45 2 (8,0) 0 (0,0) 2 (16,7) NOL Index 45 min 0,511 < 10 21 (84,0) 11 (84,6) 10 (83,3) 10–25 3 (12,0) 2 (15,4) 1 (8,3) 26–45 1 (4,0) 0 (0,0) 1 (8,3) NOL Index 60 min 0,132 < 10 21 (87,5) 13 (100) 8 (72,7) 10–25 2 (8,3) 0 (0,0) 2 (18,2) 26–45 1 (4,2) 0 (0,0) 1 (9,1) NOL Index 75 min 0,488 < 10 20 (87,0) 12 (92,3) 8 (80,0) 10–25 2 (8,7) 1 (7,7) 1 (10,0) 26–45 1 (4,3) 0 (0,0) 1 (10,0) NOL Index 90 min 0,174 < 10 15 (75,0) 10 (90,9) 5 (55,6) 10–25 4 (20,0) 1 (9,1) 3 (33,3) 26–45 1 (5,0) 0 (0,0) 1 (11,1) NOL Index 105 min 0,529 < 10 12 (80,0) 7 (87,5) 5 (71,4) 10–25 2 (13,3) 1 (12,5) 1 (14,3) 26–45 1 (6,7) 0 (0,0) 1 (14,3) *values expressed as mean ± SD or n (%), as appropriate Table 2 (cont.). NOL Index Comparison Between OFA and OBA (n = 60) Variáveis* Amostra total n = 60 (100%) OFA n = 30 (50%) OBA n = 30 (50%) P NOL Index 120 min 0,245 < 10 10 (71,4) 7 (87,5) 3 (50,0) 10–25 4 (28,6) 1 (12,5) 3 (50,0) NOL Index 135 min 1,000 < 10 8 (80,0) 6 (85,7) 2 (66,7) 10–25 2 (20,0) 1 (14,3) 1 (33,3) NOL Index 150 min 1,000 < 10 2 (66,7) 1 (100) 1 (50,0) 10–25 1 (33,3) 0 (0,0) 1 (50,0) NOL Index 165 min < 10 2 (100) 1 (100) 1 (100) - NOL Index 180 min 1,000 < 10 1 (50,0) 1 (100) 0 (0,0) 10–25 1 (50,0) 0 (0,0) 1 (100) *values expressed as mean ± SD or n (%), as appropriate The OFA group demonstrated significantly lower postoperative pain scores compared with the OBA group: At PACU discharge: p = 0.004; Within the first 24 hours: p = 0.035; At hospital discharge: p = 0.023. Additionally, the need for rescue analgesia was significantly lower in the OFA group (p = 0.002) (Table 3 ). Table 3 Comparison Between OFA and OBA Regarding Postoperative Pain During Hospitalization (n = 60) Characteristics Total sample n = 60 (100%) OFA n = 30 (50%) OBA n = 30 (50%) p Postoperative Paine (NRS) PACU Admission PACU Discharge First 24 hours Hospital Discharge 1 (0–4) 2 (0–3) 2 (1–4) 0 (0–2) 0 (0–2) 1 (0–3) 1 (0–3) 0 (0–0) 2,5 (0–5,5) 3 (1–5) 3 (2–4) 0 (0–2) 0,051 0,004 0,035 0,023 Need for rescue analgesia 0,002 Yes 31 (51,7) 9 (30,0) 22 (73,3) No 29 (48,3) 21 (70,0) 8 (26,7) Use of opioids 0,503 Yes 29 (93,5) 8 (88,9) 21 (95,5) No 2 (6,5) 1 (11,1) 1 (4,5) * Median and interquartile ranges preserved The incidence of PONV was similar between groups, with no statistically significant differences at 6 or 24 hours (Table 4 ). Table 4 PONV Occurrence in OFA vs OBA Groups (n = 60) Characteristics Total sample n = 60 (100%) OFA n = 30 (50%) OBA n = 30 (50%) p n (%) n (%) n (%) PONV Impact Scale Score 6 h PO 0,963 0 44 (73,3) 22 (73,3) 22 (73,3) 1 7 (11,7) 4 (13,3) 3 (10,0) 2 7 (11,7) 3 (10,0) 4 (13,3) ≥ 3 2 (3,3) 1 (3,3) 1 (3,3) PONV Impact Scale Score 24 h PO 0,503 0 53 (88,3) 27 (90,0) 26 (86,7) 1 2 (3,3) 1 (3,3) 1 (3,3) 2 3 (5,0) 2 (6,7) 1 (3,3) ≥ 3 2 (3,3) 0 (0,0) 2 (6,7) Need for PONV treatment 1,000 Sim 9 (15,0) 5 (16,7) 4 (13,3) Não 51 (85,0) 25 (83,3) 26 (86,7) *values expressed as mean ± SD or n (%), as appropriate Patient satisfaction was high in both groups, with a slight but non-significant tendency favoring the OFA group (p = 0.331) (Fig. 2 ). No significant intraoperative or postoperative complications were observed in either group. Discussion In this study, we observed that, consistent with the prevailing literature, the majority of patients undergoing bariatric surgery were younger women, with a high prevalence of hypertension, dyslipidemia, and depression.⁹ These findings align with those of previous research, which consistently reports a female predominance among bariatric surgery candidates, often at younger ages and motivated by psychosocial factors, sociocultural pressures related to body image, and reproductive health considerations. Furthermore, as described in the literature, these women tend to present with significant metabolic comorbidities and a greater negative impact of obesity on quality of life—factors that together contribute to increased demand for surgical treatment and higher referral rates from primary healthcare.¹⁰ Regarding the intraoperative period, data on nociception blockade, stress response modulation, and the long-term consequences of OFA remain limited. Repeated nociceptive stimulation leads to central sensitization, defined by the International Association for the Study of Pain (IASP) as “an increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold input” .¹¹ This phenomenon contributes to the development of acute and persistent postoperative pain 12 , 13 and inadequate treatment of acute postoperative pain is a key factor in the transition to chronic pain. It remains unclear whether the drugs used in OFA—weak analgesics (α₂-agonists, ketamine, lidocaine) and others without direct analgesic effect—provide hemodynamic stability by effectively attenuating nociception, or if they simply blunt sympathetic nervous system responses.¹⁴ Opioid-free anesthesia appears to reduce perioperative stress in bariatric patients. Mulier et al. demonstrated lower cortisol concentrations in patients receiving OFA during laparoscopic bariatric surgery.¹⁵ Campos-Pérez et al. also showed that OFA reduced the stress-mediated immune response in patients undergoing laparoscopic gastric bypass, evidenced by lower serum interleukin-6 (IL-6).¹⁶ IL-6 is a key pro-inflammatory cytokine and biomarker of inflammation and immune activation. In that study, however, no differences were observed in TNF-α or IL-1β levels, nor in clinical indicators such as PONV incidence or NRS pain scores. Among the various methods for intraoperative nociception monitoring, the NOL (Nociception Level) Index stands out. It integrates multiple autonomic parameters triggered by sympathetic activation in response to nociceptive stimuli, generating a score from 0 (no nociceptive response) to 100 (extreme nociception). 17 , 18 Its use helps optimize analgesia, promote hemodynamic stability, and avoid analgesic overdosing. In our study, although NOL monitoring was applied in a limited number of patients, results suggested a statistically significant advantage of OFA over OBA at the 15-minute interval, indicating better intraoperative nociception control. These findings support those of Mulier and Campos-Pérez¹⁵ , ¹⁶, which demonstrated reduced stress response and inflammatory activation in OFA patients. Although these studies did not reveal differences in immediate clinical outcomes such as PONV or early postoperative pain, it is plausible that reduced neuroendocrine stress and inflammatory activation may translate into meaningful clinical benefits, including lower postoperative complication risk, faster functional recovery, and potential reductions in chronic pain development. Despite these encouraging findings, further prospective studies with larger samples and long-term follow-up are required to determine whether improved nociception control with OFA yields significant clinical gains. Regarding the postoperative period, several prospective studies 15 , 19 – 22 have demonstrated a significant reduction in PONV among bariatric patients receiving OFA. Similarly, Ao, Yichan et al., in a meta-analysis of 12 randomized trials with 922 patients, found that OFA significantly reduced PONV compared with opioid-sparing or opioid-based anesthesia.²³ Mulier and Mieszczanski also showed that this benefit persists up to 24 hours postoperatively.¹⁵ , ²⁰ Ahmed et al., however, observed reductions in pain only in the immediate postoperative period.¹⁹ In our study, PONV incidence was similar between groups (Table 4 ), which may be influenced by the unequal antiemetic prophylaxis (dual prophylaxis in OBA vs single agent in OFA), representing a confounding factor. Our findings show that OFA was more effective in controlling postoperative pain, with lower pain scores at all measured time points and significantly reduced need for rescue analgesia. These results are consistent with several studies—particularly that of Mulier et al., in which opioid use in PACU was significantly reduced in OFA patients (4.9 mg vs 15.3 mg morphine, p = 0.04), accompanied by lower VAS scores (1.7 vs 4.9, p = 0.01).¹⁵ Ahmed et al. reported similar early benefits, although the difference in total postoperative morphine consumption—despite statistical significance—was clinically small (5.8 mg vs 7.2 mg).¹⁹ Mieszczanski et al. also observed reduced early opioid requirements.²⁰ Unlike many previous studies, the benefits in our trial persisted throughout the first 24 hours and until hospital discharge. One possible explanation is that, in most studies, OFA infusions are stopped at the end of surgery.²⁴ , ²⁵ In contrast, our protocol continued the infusion into early recovery, similar to Ulbing et al., who reported reduced opioid use and lower VAS scores with postoperative continuation of adjuvant agents.²⁶ Despite growing evidence supporting OFA, definitive proof of its superiority is still lacking. Hung et al., in a meta-analysis of bariatric surgery, found a statistically significant reduction in NRS pain scores at 24 hours in OFA patients; however, the difference was less than 1 point, raising doubts about its clinical relevance.²⁷ The authors also found no significant reduction in total opioid consumption beyond the immediate postoperative period. Similarly, Menck et al. found no significant differences in pain scores or opioid requirements at any time point.²⁸ Although maintaining infusion of co-analgesics may prolong the benefits of OFA, further research is needed to determine whether such benefits are clinically meaningful. Future Perspectives Future studies should focus on larger samples and include multiple clinical settings to confirm and expand upon the findings of this study. Additionally, investigating the application of OFA in other surgical contexts may help establish its broader utility and effectiveness across a wider range of procedures. Limitations This study presents several limitations. First, the sample size was relatively small, which may restrict the generalizability of the findings. Larger-scale studies are needed to confirm these results. Second, the study was conducted at a single center , which may introduce selection bias. Conducting multicenter studies would help validate these results across diverse populations and clinical environments. Finally, differences in antiemetic prophylaxis protocols between groups may have influenced the interpretation of PONV incidence, acting as a potential confounder. Future studies should implement standardized prophylaxis protocols across groups to enable more accurate comparisons. Conclusion Opioid-free anesthesia (OFA) represents a viable and advantageous alternative for patients undergoing bariatric and metabolic surgery. It demonstrated superiority in reducing postoperative pain and the need for rescue analgesia, while potentially mitigating the adverse effects associated with opioid use. These benefits contribute to improved patient recovery and may reduce hospital length of stay. Patient satisfaction was high in both groups, reinforcing the feasibility and acceptance of the technique. Despite the limitations of this study, the results align with current evidence and support continued research in this area. Larger multicenter studies will be essential to confirm these findings and assess the long-term impact of OFA in bariatric surgery. Given the benefits demonstrated here and in other studies, OFA deserves increasing incorporation into clinical practice as a preferred anesthetic strategy for bariatric surgery—whenever no contraindications exist—contributing to safer, patient-centered perioperative protocols. Declarations Authors' contributions: E.J.A. conceived the study, participated in the interpretation of the data, and wrote the main text of the manuscript. F.M.A. conceived the study and revised the manuscript. R.R. and C.R. performed the formal analysis and revised the manuscript. CONSORT declaration This study adheres to the CONSORT 2010 guidelines for reporting randomized controlled trials. A completed CONSORT checklist is provided as an additional file. Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The study was submitted to and approved by the Ethics Committee of Hospital Lusíadas Amadora. Written informed consent to participate was obtained from all individual participants prior to enrolment. Consent for publication Not applicable. No identifying images or personal clinical details of participants are included in this manuscript. Avaliability of data and materials The datasets generated and analysed during the current study are available from the corresponding author on reasonable request. Acknowledgments We extend our gratitude to all patentes who willingly agreed to participate in this study, as well as to the entire team of the Multidisciplinary Center for the Treatment of Obesity, particularly Dr. Rui Ribeiro and Prof. Dr. Carina Rossoni, whose motivation and proactive engagement greatly facilitated the development of the study. We also thank Medtronic® representative Mafalda Oliveira, distributor of the NOL monitor, who generously provided access to the technology without any financial compensation, significantly contributing to the relevance of the study’s findings. Conflicts of Interest The authors declare no conflicts of interest related to this study. Funding None. References Alberti KGMM, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interm statement of the International Diabetes Federation Task Force on epidemiology and prevention ; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120: 1640–1645. Mechanick J, Youdim A, Jones DB, et al. 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Open Anesth J. 2022;16:e258964582208110. Additional Declarations No competing interests reported. Supplementary Files Table1AnestheticProtocols.docx Table2DemographicandClinicalCharacteristicsofParticipants.docx Table3NOLIndexComparisonBetweenOFAandOBA.docx Table4ComparisonBetweenOFAandOBARegardingPostoperativePain.docx Table5PONVOccurrenceinOFAvsOBAGroups.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviews received at journal 05 Feb, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers invited by journal 20 Jan, 2026 Editor assigned by journal 20 Jan, 2026 Submission checks completed at journal 15 Jan, 2026 First submitted to journal 15 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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The latter is defined by the presence of three of the following five criteria: waist circumference\u0026thinsp;\u0026gt;\u0026thinsp;102 cm (men) or \u0026gt;\u0026thinsp;88 cm (women); triglycerides\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dL; HDL cholesterol\u0026thinsp;\u0026lt;\u0026thinsp;40 mg/dL (men) or \u0026lt;\u0026thinsp;50 mg/dL (women); blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;130/85 mmHg; fasting glucose\u0026thinsp;\u0026gt;\u0026thinsp;100 mg/dL.\u0026sup1;\u003c/p\u003e \u003cp\u003eBariatric surgery is widely recognized as the most effective intervention for sustained weight loss, control of obesity-related comorbidities, and improvement in life expectancy in severe cases.\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Approximately 600,000 patients undergo bariatric surgery annually, with an even larger population meeting criteria for the procedure.\u0026sup2;\u003c/p\u003e \u003cp\u003eThe most commonly reported perioperative complications include deep vein thrombosis (DVT) / pulmonary embolism (PE), anastomotic leak, respiratory failure, hemorrhage, and surgical site infection.\u0026sup3;\u003c/p\u003e \u003cp\u003eIn high-volume reference centers, bariatric surgery carries a 30-day mortality rate of 0.5% and a morbidity rate of 5%.\u0026sup3;\u003c/p\u003e \u003cp\u003eOver recent years, the Enhanced Recovery After Surgery (ERAS) program has gained worldwide adoption across multiple surgical specialties. This program \u0026mdash; consisting of a series of evidence-based, multidisciplinary perioperative interventions primarily aimed at improving postoperative recovery \u0026mdash; has been shown to reduce morbidity, hospital length of stay, and associated costs, while increasing patient satisfaction.⁵ The first ERAS guidelines for perioperative management in bariatric surgery were published in 2016 and later updated in 2021 to reflect evolving evidence.⁵\u003c/p\u003e \u003cp\u003eDespite these updates, current scientific evidence still does not allow the recommendation of a specific anesthetic technique or specific anesthetic agents. However, there is consensus that the use of drugs that are rapidly reversible and fast-acting, while minimizing opioid exposure, contributes to improved postoperative recovery.⁵\u003c/p\u003e \u003cp\u003eIn opioid-based anesthesia (OBA)\u0026mdash;traditionally used to achieve antinociception\u0026mdash;remifentanil is the drug of choice. Nevertheless, rapid tolerance to opioids, along with a well-known profile of postoperative adverse effects (nausea and vomiting, respiratory depression, prolonged sedation, urinary retention, ileus, postoperative hyperalgesia, and chronic pain)⁶, may prolong hospitalization or even result in unplanned readmissions.\u003c/p\u003e \u003cp\u003eRecently, there has been a growing shift toward opioid-free anesthesia (OFA), focusing on the use of adjuvant drugs (lidocaine, dexmedetomidine, ketamine, etc.) and regional anesthesia to achieve hypnosis, amnesia, and hemodynamic stability, while avoiding the adverse effects associated with opioids. This approach has demonstrated a more favorable profile, contributing to earlier return of bowel motility, reduced postoperative hyperalgesia, and lower incidence of postoperative nausea and vomiting (PONV).⁵\u003c/p\u003e \u003cp\u003eGiven these considerations, the objective of this study was to compare the efficacy and safety of opioid-based anesthesia (OBA) versus opioid-free anesthesia (OFA) in patients undergoing laparoscopic bariatric surgery. We hypothesized that the OFA technique would result in improved pain control, lower incidence of PONV, and greater overall patient satisfaction.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a prospective study including 60 individuals undergoing laparoscopic bariatric surgery. Inclusion criteria were: age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; body mass index (BMI)\u0026thinsp;\u0026ge;\u0026thinsp;35 kg/m\u0026sup2; with associated comorbidities, or BMI\u0026thinsp;\u0026ge;\u0026thinsp;40 kg/m\u0026sup2;. Exclusion criteria were: pregnancy, history of substance abuse, or severe psychiatric disease. No formal sample size calculation was performed. The sample size was determined pragmatically based on the number of eligible patients undergoing bariatric surgery during the study period.\u003c/p\u003e\n\u003cp\u003eParticipants were randomly allocated using a computerized system to ensure random distribution into two groups (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eOBA Group \u0026mdash; opioid-based anesthesia (n\u0026thinsp;=\u0026thinsp;30);\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u0026nbsp;OFA Group \u0026mdash; opioid-free anesthesia (n\u0026thinsp;=\u0026thinsp;30).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEach participant underwent an anesthetic intervention according to the respective protocol (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnesthetic Protocols\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOBA group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOFA group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStandard monitoring\u0026thinsp;+\u0026thinsp;BIS\u0026thinsp;+\u0026thinsp;TOF\u0026thinsp;+\u0026thinsp;NOL\u003c/p\u003e\n \u003cp\u003eVenous catheterization and initiation of goal-directed fluid therapy with balanced crystalloid\u003c/p\u003e\n \u003cp\u003eStart of remifentanil infusion (2 mg / 40 mL saline)\u003c/p\u003e\n \u003cp\u003eInduction with propofol\u003c/p\u003e\n \u003cp\u003eNeuromuscular blockade with rocuronium\u003c/p\u003e\n \u003cp\u003eMaintenance with desflurane\u003c/p\u003e\n \u003cp\u003ePONV prophylaxis with dexamethasone 4\u0026ndash;8 mg after induction\u003c/p\u003e\n \u003cp\u003eAntibiotic prophylaxis with cefazolin 2\u0026ndash;4 g\u003c/p\u003e\n \u003cp\u003eStress-ulcer prophylaxis with esomeprazole 40 mg\u003c/p\u003e\n \u003cp\u003ePostoperative analgesia: paracetamol\u0026thinsp;+\u0026thinsp;ketorolac/parecoxib\u0026thinsp;+\u0026thinsp;metamizole\u003c/p\u003e\n \u003cp\u003eAdministration of ondansetron 4 mg and droperidol 0.625 mg 30 minutes before the end of surgery\u003c/p\u003e\n \u003cp\u003eTermination of remifentanil infusion at the end of surgery\u003c/p\u003e\n \u003cp\u003eReversal of neuromuscular blockade with sugammadex\u003c/p\u003e\n \u003cp\u003eRescue analgesia in PACU with tramadol 100 mg and/or morphine\u003c/p\u003e\n \u003cp\u003ePONV treatment in PACU with ondansetron 4 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStandard monitoring\u0026thinsp;+\u0026thinsp;BIS\u0026thinsp;+\u0026thinsp;TOF\u0026thinsp;+\u0026thinsp;NOL\u003c/p\u003e\n \u003cp\u003eVenous catheterization and initiation of goal-directed fluid therapy with balanced crystalloid\u003c/p\u003e\n \u003cp\u003eBolus of dexmedetomidine 15\u0026ndash;20 \u0026micro;g followed by infusion: dexmedetomidine 50 \u0026micro;g\u0026thinsp;+\u0026thinsp;ketamine 50 mg\u0026thinsp;+\u0026thinsp;lidocaine 500 mg in 50 mL saline (rate: 1 mL / 10 kg total body weight)\u003c/p\u003e\n \u003cp\u003eInduction with propofol\u003c/p\u003e\n \u003cp\u003eNeuromuscular blockade with rocuronium\u003c/p\u003e\n \u003cp\u003eMaintenance with desflurane\u003c/p\u003e\n \u003cp\u003ePONV prophylaxis with dexamethasone 4\u0026ndash;8 mg after induction\u003c/p\u003e\n \u003cp\u003eAntibiotic prophylaxis with cefazolin 2\u0026ndash;4 g\u003c/p\u003e\n \u003cp\u003eStress-ulcer prophylaxis with esomeprazole 40 mg\u003c/p\u003e\n \u003cp\u003ePostoperative analgesia: paracetamol\u0026thinsp;+\u0026thinsp;ketorolac/parecoxib\u0026thinsp;+\u0026thinsp;metamizole\u003c/p\u003e\n \u003cp\u003eInfusion rate reduced by half 30 minutes before the end of surgery (continued for 1 hour in PACU, until completion or discharge)\u003c/p\u003e\n \u003cp\u003eReversal of neuromuscular blockade with sugammadex\u003c/p\u003e\n \u003cp\u003eRescue analgesia in PACU with tramadol 100 mg\u003c/p\u003e\n \u003cp\u003ePONV treatment in PACU with ondansetron 4 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eVariables:\u003c/h2\u003e\n \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\n \u003ch2\u003eDemographic variables\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eAnthropometric and clinical variables\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eWeight, height, BMI\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eComorbidities (HTN, T2DM, OSAS/OHS)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eRegular medication (\u0026beta;-blockers, antihypertensives, statins, glucocorticoids, synthetic opioids, antidepressants, others)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAlcohol and tobacco use\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eSurgical variables\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eProcedure performed\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSurgical duration\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIntraoperative and postoperative complications\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLength of hospital stay\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eAnesthetic variables\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIntraoperative analgesia (Nociception Level Index \u0026ndash; NOL, Medasense\u0026reg;)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePostoperative pain (Numerical Rating Scale, NRS) assessed:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eupon PACU arrival\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eat PACU discharge\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ewithin first 24 postoperative hours\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eat hospital discharge\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNeed for rescue analgesia (with or without opioids)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIncidence of PONV and need for treatment\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePONV Impact Scale Score at 6 and 24 hours postoperatively\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eBiochemical variables\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eHemoglobin, leukocytes, C-reactive protein (CRP), procalcitonin, erythrocyte sedimentation rate (ESR)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003ch3\u003ePatient satisfaction\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAssessed using a 1\u0026ndash;10 scale (1\u0026thinsp;=\u0026thinsp;not at all satisfied; 10\u0026thinsp;=\u0026thinsp;very satisfied)\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eQuantitative variables were described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median and interquartile range, depending on distribution (assessed via the Shapiro\u0026ndash;Wilk test). Categorical variables were expressed as absolute and relative frequencies.\u003c/p\u003e\n\u003cp\u003eMeans were compared using the Student\u0026rsquo;s t-test; for non-parametric distributions, the Mann\u0026ndash;Whitney test was used. Proportions were compared using Pearson\u0026rsquo;s chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e\n\u003cp\u003eTo control for confounders, a generalized linear model (GLM) with Bonferroni correction was applied: Tweedie model with log link \u0026rarr; asymmetric variables; Linear model \u0026rarr; symmetric variables; Binary logistic model \u0026rarr; dichotomous variables.\u003c/p\u003e\n\u003cp\u003eThe significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed using SPSS version 28.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study population (n\u0026thinsp;=\u0026thinsp;60) was predominantly female (76.7%), with a mean age of 44.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 years and a mean BMI of 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 kg/m\u0026sup2;. The most prevalent comorbidity was hypertension (36.7%), followed by dyslipidemia and depressive syndrome. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the demographic and clinical characteristics of the participants.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic and Clinical Characteristics of Participants (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristics*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal Sample\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 (100%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOFA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOBA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44,9\u0026thinsp;\u0026plusmn;\u0026thinsp;10,6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47,2\u0026thinsp;\u0026plusmn;\u0026thinsp;10,3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42,7\u0026thinsp;\u0026plusmn;\u0026thinsp;10,5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,102\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBiological Sex\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,760\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (23,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (26,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46 (76,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (80,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol consumption\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,302\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (48,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (56,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (40,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOccasional\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (43,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (56,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRegular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (23,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,747\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAnthropometrics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWeight (kg)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e109,1\u0026thinsp;\u0026plusmn;\u0026thinsp;18,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110,5\u0026thinsp;\u0026plusmn;\u0026thinsp;20,1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e107,8\u0026thinsp;\u0026plusmn;\u0026thinsp;17,9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,596\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeight (m)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,67\u0026thinsp;\u0026plusmn;\u0026thinsp;0,07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,67\u0026thinsp;\u0026plusmn;\u0026thinsp;0,08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,66\u0026thinsp;\u0026plusmn;\u0026thinsp;0,06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,375\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI (kg∕m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39,1\u0026thinsp;\u0026plusmn;\u0026thinsp;5,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39,3\u0026thinsp;\u0026plusmn;\u0026thinsp;5,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39,0\u0026thinsp;\u0026plusmn;\u0026thinsp;5,0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,815\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (36,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (43,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (30,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,422\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDyslipidemia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (33,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (40,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (26,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,411\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eType 2 Diabetes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (11,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOSAS/OHS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (21,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (23,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMetabolic Syndrome\u003c/p\u003e\n\u003cp\u003eAsthma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1,7)\u003c/p\u003e\n\u003cp\u003e3 (5,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGERD/Gastritis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,195\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (31,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (43,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,096\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFibromyalgia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHipothyroidism\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,706\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEpilepsy\u003c/p\u003e\n\u003cp\u003eChronic medication\u003c/p\u003e\n\u003cp\u003e\u0026beta;-blockers\u003c/p\u003e\n\u003cp\u003eOther anti-hypertensives\u003c/p\u003e\n\u003cp\u003eStatins\u003c/p\u003e\n\u003cp\u003eGlucocorticoids\u003c/p\u003e\n\u003cp\u003eAntidepressives\u003c/p\u003e\n\u003cp\u003eOral Antidiabetics\u003c/p\u003e\n\u003cp\u003eBronchodilators\u003c/p\u003e\n\u003cp\u003eAnticonvulsants\u003c/p\u003e\n\u003cp\u003eLevothyroxine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3,3)\u003c/p\u003e\n\u003cp\u003e39 (65,0)\u003c/p\u003e\n\u003cp\u003e7 (11,7)\u003c/p\u003e\n\u003cp\u003e14 (23,3)\u003c/p\u003e\n\u003cp\u003e17 (28,3)\u003c/p\u003e\n\u003cp\u003e1 (1,7)\u003c/p\u003e\n\u003cp\u003e21 (35,0)\u003c/p\u003e\n\u003cp\u003e6 (10,0)\u003c/p\u003e\n\u003cp\u003e4 (6,7)\u003c/p\u003e\n\u003cp\u003e2 (3,3)\u003c/p\u003e\n\u003cp\u003e8 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003cp\u003e21 (70,0)\u003c/p\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003cp\u003e8 (26,7)\u003c/p\u003e\n\u003cp\u003e11 (36,7)\u003c/p\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003cp\u003e15 (50,0)\u003c/p\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003cp\u003e18 (60,0)\u003c/p\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003cp\u003e6 (20,0)\u003c/p\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003cp\u003e5 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0,492\u003c/p\u003e\n\u003cp\u003e0,588\u003c/p\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003cp\u003e0,760\u003c/p\u003e\n\u003cp\u003e0,252\u003c/p\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003cp\u003e0,030\u003c/p\u003e\n\u003cp\u003e0,671\u003c/p\u003e\n\u003cp\u003e0,612\u003c/p\u003e\n\u003cp\u003e0,492\u003c/p\u003e\n\u003cp\u003e0,706\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*values expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%), as appropriate\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAt the 15-minute measurement point, the NOL index was significantly higher in the OBA group (p\u0026thinsp;=\u0026thinsp;0.041). At other time points, lower NOL values were generally more frequent in the OFA group, though without statistical significance. (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" style=\"width: 512px;\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNOL Index Comparison Between OFA and OBA (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariables*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal sample\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 (100%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eOFA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eOBA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Measurement Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeasured\u003c/p\u003e\n\u003cp\u003eNot Measured\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25 (41,7)\u003c/p\u003e\n\u003cp\u003e35 (58,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13 (43,3)\u003c/p\u003e\n\u003cp\u003e17 (56,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12 (40,0)\u003c/p\u003e\n\u003cp\u003e18 (60,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e15 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e25 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e30 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e25 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e45 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e25 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e60 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e24 (96,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11 (91,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,480\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e75 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e23 (92,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (83,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,220\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e90 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e20 (80,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e11 (84,6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (75,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,645\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e105 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e15 (60,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e8 (61,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e7 (58,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e120 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e14 (56,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e8 (61,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,859\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e135 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (41,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e7 (53,8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (27,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,240\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e150 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (12,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (7,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,593\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e165 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (8,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (7,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (8,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e180 min\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (8,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (7,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (8,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 15 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,041\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e16 (64,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e11 (84,6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (41,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (36,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e2 (15,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e7 (58,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 30 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,056\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e18 (72,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e12 (92,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (7,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4 (33,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (8,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 45 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,511\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e21 (84,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e11 (84,6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (83,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (12,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e2 (15,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (8,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (4,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (8,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 60 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,132\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e21 (87,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e8 (72,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (8,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (18,2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (4,2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (9,1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 75 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,488\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e20 (87,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e12 (92,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e8 (80,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (8,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (7,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (4,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 211.076px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 90 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 99.1551px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 31.5186px;\" align=\"left\"\u003e\n\u003cp\u003e0,174\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e15 (75,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e10 (90,9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (55,6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (9,1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (33,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (5,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (11,1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 105 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0,529\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (80,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e7 (87,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (71,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e1 (12,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (14,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 201.076px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 105.486px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (6,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 107.674px;\" colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 97.6736px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (14,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 33.0001px;\" colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003e*values expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%), as appropriate\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003e(cont.). NOL Index Comparison Between OFA and OBA (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVari\u0026aacute;veis*\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAmostra total\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 (100%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOFA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOBA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 120 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,245\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (71,4)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (87,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (28,6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (12,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 135 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (80,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (85,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (66,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (20,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (14,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (33,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 150 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (66,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (33,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 165 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNOL Index 180 min\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (50,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (100)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*values expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%), as appropriate\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe OFA group demonstrated significantly lower postoperative pain scores compared with the OBA group:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eAt PACU discharge: p\u0026thinsp;=\u0026thinsp;0.004;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWithin the first 24 hours: p\u0026thinsp;=\u0026thinsp;0.035;\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAt hospital discharge: p\u0026thinsp;=\u0026thinsp;0.023.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAdditionally, the need for rescue analgesia was significantly lower in the OFA group (p\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison Between OFA and OBA Regarding Postoperative Pain During Hospitalization (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal sample\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 (100%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOFA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOBA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Paine (NRS)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePACU Admission\u003c/p\u003e\n\u003cp\u003ePACU Discharge\u003c/p\u003e\n\u003cp\u003eFirst 24 hours\u003c/p\u003e\n\u003cp\u003eHospital Discharge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0\u0026ndash;4)\u003c/p\u003e\n\u003cp\u003e2 (0\u0026ndash;3)\u003c/p\u003e\n\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\n\u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n\u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e\n\u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e\n\u003cp\u003e0 (0\u0026ndash;0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2,5 (0\u0026ndash;5,5)\u003c/p\u003e\n\u003cp\u003e3 (1\u0026ndash;5)\u003c/p\u003e\n\u003cp\u003e3 (2\u0026ndash;4)\u003c/p\u003e\n\u003cp\u003e0 (0\u0026ndash;2)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,051\u003c/p\u003e\n\u003cp\u003e0,004\u003c/p\u003e\n\u003cp\u003e0,035\u003c/p\u003e\n\u003cp\u003e0,023\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeed for rescue analgesia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (51,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (30,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (48,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (70,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (26,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUse of opioids\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,503\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (93,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (88,9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (95,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (11,1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (4,5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e* Median and interquartile ranges preserved\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;The incidence of PONV was similar between groups, with no statistically significant differences at 6 or 24 hours (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab9\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePONV Occurrence in OFA vs OBA Groups (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal sample\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;60 (100%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOFA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOBA\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;30 (50%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ep\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePONV Impact Scale Score 6 h PO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,963\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (73,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (11,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (11,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (10,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePONV Impact Scale Score 24 h PO\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0,503\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53 (88,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27 (90,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (86,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (5,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (6,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNeed for PONV treatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1,000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSim\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (15,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (16,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (13,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eN\u0026atilde;o\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e51 (85,0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (83,3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (86,7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*values expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or n (%), as appropriate\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cp\u003ePatient satisfaction was high in both groups, with a slight but non-significant tendency favoring the OFA group (p\u0026thinsp;=\u0026thinsp;0.331) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eNo significant intraoperative or postoperative complications were observed in either group.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we observed that, consistent with the prevailing literature, the majority of patients undergoing bariatric surgery were younger women, with a high prevalence of hypertension, dyslipidemia, and depression.⁹ These findings align with those of previous research, which consistently reports a female predominance among bariatric surgery candidates, often at younger ages and motivated by psychosocial factors, sociocultural pressures related to body image, and reproductive health considerations. Furthermore, as described in the literature, these women tend to present with significant metabolic comorbidities and a greater negative impact of obesity on quality of life\u0026mdash;factors that together contribute to increased demand for surgical treatment and higher referral rates from primary healthcare.\u0026sup1;⁰\u003c/p\u003e \u003cp\u003eRegarding the intraoperative period, data on nociception blockade, stress response modulation, and the long-term consequences of OFA remain limited.\u003c/p\u003e \u003cp\u003eRepeated nociceptive stimulation leads to central sensitization, defined by the International Association for the Study of Pain (IASP) as \u003cem\u003e\u0026ldquo;an increased responsiveness of nociceptive neurons in the central nervous system to their normal or subthreshold input\u0026rdquo;\u003c/em\u003e.\u0026sup1;\u0026sup1; This phenomenon contributes to the development of acute and persistent postoperative pain\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and inadequate treatment of acute postoperative pain is a key factor in the transition to chronic pain.\u003c/p\u003e \u003cp\u003eIt remains unclear whether the drugs used in OFA\u0026mdash;weak analgesics (α₂-agonists, ketamine, lidocaine) and others without direct analgesic effect\u0026mdash;provide hemodynamic stability by effectively attenuating nociception, or if they simply blunt sympathetic nervous system responses.\u0026sup1;⁴\u003c/p\u003e \u003cp\u003eOpioid-free anesthesia appears to reduce perioperative stress in bariatric patients.\u003c/p\u003e \u003cp\u003eMulier et al. demonstrated lower cortisol concentrations in patients receiving OFA during laparoscopic bariatric surgery.\u0026sup1;⁵ Campos-P\u0026eacute;rez et al. also showed that OFA reduced the stress-mediated immune response in patients undergoing laparoscopic gastric bypass, evidenced by lower serum interleukin-6 (IL-6).\u0026sup1;⁶ IL-6 is a key pro-inflammatory cytokine and biomarker of inflammation and immune activation. In that study, however, no differences were observed in TNF-α or IL-1β levels, nor in clinical indicators such as PONV incidence or NRS pain scores.\u003c/p\u003e \u003cp\u003eAmong the various methods for intraoperative nociception monitoring, the NOL (Nociception Level) Index stands out. It integrates multiple autonomic parameters triggered by sympathetic activation in response to nociceptive stimuli, generating a score from 0 (no nociceptive response) to 100 (extreme nociception).\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Its use helps optimize analgesia, promote hemodynamic stability, and avoid analgesic overdosing.\u003c/p\u003e \u003cp\u003eIn our study, although NOL monitoring was applied in a limited number of patients, results suggested a statistically significant advantage of OFA over OBA at the 15-minute interval, indicating better intraoperative nociception control. These findings support those of Mulier and Campos-P\u0026eacute;rez\u0026sup1;⁵\u003csup\u003e,\u003c/sup\u003e\u0026sup1;⁶, which demonstrated reduced stress response and inflammatory activation in OFA patients. Although these studies did not reveal differences in immediate clinical outcomes such as PONV or early postoperative pain, it is plausible that reduced neuroendocrine stress and inflammatory activation may translate into meaningful clinical benefits, including lower postoperative complication risk, faster functional recovery, and potential reductions in chronic pain development.\u003c/p\u003e \u003cp\u003eDespite these encouraging findings, further prospective studies with larger samples and long-term follow-up are required to determine whether improved nociception control with OFA yields significant clinical gains.\u003c/p\u003e \u003cp\u003eRegarding the postoperative period, several prospective studies\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e have demonstrated a significant reduction in PONV among bariatric patients receiving OFA. Similarly, Ao, Yichan et al., in a meta-analysis of 12 randomized trials with 922 patients, found that OFA significantly reduced PONV compared with opioid-sparing or opioid-based anesthesia.\u0026sup2;\u0026sup3; Mulier and Mieszczanski also showed that this benefit persists up to 24 hours postoperatively.\u0026sup1;⁵\u003csup\u003e,\u003c/sup\u003e\u0026sup2;⁰\u003c/p\u003e \u003cp\u003eAhmed et al., however, observed reductions in pain only in the immediate postoperative period.\u0026sup1;⁹\u003c/p\u003e \u003cp\u003eIn our study, PONV incidence was similar between groups (Table \u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e4\u003c/span\u003e), which may be influenced by the unequal antiemetic prophylaxis (dual prophylaxis in OBA vs single agent in OFA), representing a confounding factor.\u003c/p\u003e \u003cp\u003eOur findings show that OFA was more effective in controlling postoperative pain, with lower pain scores at all measured time points and significantly reduced need for rescue analgesia.\u003c/p\u003e \u003cp\u003eThese results are consistent with several studies\u0026mdash;particularly that of Mulier et al., in which opioid use in PACU was significantly reduced in OFA patients (4.9 mg vs 15.3 mg morphine, p\u0026thinsp;=\u0026thinsp;0.04), accompanied by lower VAS scores (1.7 vs 4.9, p\u0026thinsp;=\u0026thinsp;0.01).\u0026sup1;⁵ Ahmed et al. reported similar early benefits, although the difference in total postoperative morphine consumption\u0026mdash;despite statistical significance\u0026mdash;was clinically small (5.8 mg vs 7.2 mg).\u0026sup1;⁹ Mieszczanski et al. also observed reduced early opioid requirements.\u0026sup2;⁰\u003c/p\u003e \u003cp\u003eUnlike many previous studies, the benefits in our trial persisted throughout the first 24 hours and until hospital discharge. One possible explanation is that, in most studies, OFA infusions are stopped at the end of surgery.\u0026sup2;⁴\u003csup\u003e,\u003c/sup\u003e\u0026sup2;⁵ In contrast, our protocol continued the infusion into early recovery, similar to Ulbing et al., who reported reduced opioid use and lower VAS scores with postoperative continuation of adjuvant agents.\u0026sup2;⁶\u003c/p\u003e \u003cp\u003eDespite growing evidence supporting OFA, definitive proof of its superiority is still lacking. Hung et al., in a meta-analysis of bariatric surgery, found a statistically significant reduction in NRS pain scores at 24 hours in OFA patients; however, the difference was less than 1 point, raising doubts about its clinical relevance.\u0026sup2;⁷ The authors also found no significant reduction in total opioid consumption beyond the immediate postoperative period.\u003c/p\u003e \u003cp\u003eSimilarly, Menck et al. found no significant differences in pain scores or opioid requirements at any time point.\u0026sup2;⁸\u003c/p\u003e \u003cp\u003eAlthough maintaining infusion of co-analgesics may prolong the benefits of OFA, further research is needed to determine whether such benefits are clinically meaningful.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFuture Perspectives\u003c/h2\u003e \u003cp\u003eFuture studies should focus on larger samples and include multiple clinical settings to confirm and expand upon the findings of this study. Additionally, investigating the application of OFA in other surgical contexts may help establish its broader utility and effectiveness across a wider range of procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study presents several limitations. First, the sample size was relatively small, which may restrict the generalizability of the findings. Larger-scale studies are needed to confirm these results.\u003c/p\u003e \u003cp\u003eSecond, the study was conducted at a \u003cb\u003esingle center\u003c/b\u003e, which may introduce selection bias. Conducting multicenter studies would help validate these results across diverse populations and clinical environments.\u003c/p\u003e \u003cp\u003eFinally, differences in antiemetic prophylaxis protocols between groups may have influenced the interpretation of PONV incidence, acting as a potential confounder. Future studies should implement standardized prophylaxis protocols across groups to enable more accurate comparisons.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOpioid-free anesthesia (OFA) represents a \u003cb\u003eviable and advantageous alternative\u003c/b\u003e for patients undergoing bariatric and metabolic surgery.\u003c/p\u003e \u003cp\u003eIt demonstrated superiority in reducing postoperative pain and the need for rescue analgesia, while potentially mitigating the adverse effects associated with opioid use. These benefits contribute to improved patient recovery and may reduce hospital length of stay.\u003c/p\u003e \u003cp\u003ePatient satisfaction was high in both groups, reinforcing the feasibility and acceptance of the technique.\u003c/p\u003e \u003cp\u003eDespite the limitations of this study, the results align with current evidence and support continued research in this area. \u003cb\u003eLarger multicenter studies\u003c/b\u003e will be essential to confirm these findings and assess the long-term impact of OFA in bariatric surgery.\u003c/p\u003e \u003cp\u003eGiven the benefits demonstrated here and in other studies, OFA deserves increasing incorporation into clinical practice as a preferred anesthetic strategy for bariatric surgery\u0026mdash;whenever no contraindications exist\u0026mdash;contributing to safer, patient-centered perioperative protocols.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAuthors\u0026apos; contributions:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eE.J.A. conceived the study, participated in the interpretation of the data, and wrote the main text of the manuscript. F.M.A. conceived the study and revised the manuscript. R.R. and C.R. performed the formal analysis and revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSORT declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adheres to the CONSORT 2010 guidelines for reporting randomized controlled trials. A completed CONSORT checklist is provided as an additional file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eThe study was submitted to and approved by the Ethics Committee of Hospital Lus\u0026iacute;adas Amadora.\u003c/p\u003e\n\u003cp\u003eWritten informed consent to participate was obtained from all individual participants prior to enrolment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No identifying images or personal clinical details of participants are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvaliability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAcknowledgments\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our gratitude to all patentes who willingly agreed to participate in this study, as well as to the entire team of the Multidisciplinary Center for the Treatment of Obesity, particularly Dr. Rui Ribeiro and Prof. Dr. Carina Rossoni, whose motivation and proactive engagement greatly facilitated the development of the study.\u003c/p\u003e\n\u003cp\u003eWe also thank Medtronic\u0026reg; representative Mafalda Oliveira, distributor of the NOL monitor, who generously provided access to the technology without any financial compensation, significantly contributing to the relevance of the study\u0026rsquo;s findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eConflicts of Interest\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare \u003cstrong\u003eno conflicts of interest\u003c/strong\u003e related to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFunding\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlberti KGMM, Eckel RH, Grundy SM et al. \u003cem\u003eHarmonizing the metabolic syndrome: a joint interm statement of the International Diabetes Federation Task Force on epidemiology and prevention\u003c/em\u003e; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120: 1640\u0026ndash;1645.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMechanick J, Youdim A, Jones DB, et al. Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient \u0026ndash;\u0026thinsp;2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic \u0026amp; Bariatric Surgery. Surg Obes Relat Dis. 2013;9:159\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuidley AM, Bland CM, Brandon Bookstaver P, et al. Perioperative management of bariatric surgery patients. Am J Heath Syst Pharm. 2014;71:1253\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFried M, Yumuk V, Jean-Michel Oppert JM, et al.. Interdisciplinary European Guidelines on metabolic and Bariatric Surgery. Obes Surg. 2014;24:42\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStenberg E, Falc\u0026atilde;o LF, O\u0026rsquo;Kane M, et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery after Surgery (ERAS) Society Recommendations: A 2021 Update. World J Surg. 2022;46:729\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaerdemaeker L, Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anaesth. 2016;29:119\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011;63(Suppl 11):S240\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMyles PS, Wengritzky R. Simplified postoperative nausea and vomiting impact scale for audit and post-discharge review. Br J Anaesth. 2012;108(3):423\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoudi AM, Hammad RA, ElShafie MA, Ahmed IM, Alhadidy MA. Comparing Opioid Free General Anesthesia to Traditional Balanced General Anesthesia Regarding Achievement of Enhanced Recovery in Laparoscopic Bariatric Surgeries. Ain Shams J Anesthesiol. 2022;14:24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherif A, et al. Gender disparities in weight loss surgery. Mini-invasive Surg. 2020;4:21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternation Association for The Study of Pain. Available online: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.iasp-pain.org/resources/terminology/\u003c/span\u003e\u003cspan address=\"https://www.iasp-pain.org/resources/terminology/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCividjian A, Petitjeans F, Liu N, Ghignone M, de Kock M, Quintin L. Do We Feel Pain during Anesthesia? A Critical Review on Surgery-Evoked Circulatory Changes and Pain Perception. Best Pract Res Clin Anaesthesiol. 2017;31:445\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSearle R, Simpson K. Chronic Post-Surgical Pain. Contin Educ Anaesth Crit Care Pain. 2010;10:12\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeloeil H., Opioid-free anesthesia. Journal of Clinical Anesthesia; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMulier JP, Wouters R, Dillemans B, De Kock M. A randomized controlled, double-blind trial evaluating the effect of Opioid free versus opioid general anaesthesia on postoperative pain and discomfort measured by the QoR-40. J Clin Anesth Pain Med. 2018;2:15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampos-P\u0026eacute;rez W, Ram\u0026iacute;rez-Plascencia L, P\u0026eacute;rez-Robles M, Rivera-Vald\u0026eacute;s JJ, S\u0026aacute;nchez-Munoz P, P\u0026eacute;rez-Vargas L, Gonz\u0026aacute;lez- Landeros D, Cuevas JHM, Mart\u0026iacute;nez-L\u0026oacute;pez EA. \u003cem\u003eComparison of opioid-containing anesthesia versus opioid-free anesthesia using the Cort\u0026iacute;nez-Sep\u0026uacute;lveda model on differential cytokine responses in obese patients undergoing gastric bypass surgery: A randomized controlled trial\u003c/em\u003e. BMC Anesthesiol. 2022, 22, 294.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdry R, et al. Preliminary intraoperative validation of the NOL (Nociception Level) Index, a non-invasive nociception monitor. Anesthesiology July 2016. 2016;125:193\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartini CH et al. (2015), \u003cem\u003eAbility of the Nociception Level (NOL), a multiparameter composite of autonomic signals, to detect noxious stimuli during propofol-remifentanil anesthesia\u003c/em\u003e. Anesthesiology Sept. 2015; 123:524\u0026ndash;534.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed SA, Abdelghany MS, Afandy ME. The effect of opioid-free anesthesia on the post-operative opioid consumption in laparoscopic bariatric surgeries: A randomized controlled double-blind study. J Opioid Manag. 2022;18:47\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMieszczanski P, G\u0026oacute;rniewski G, Ziemianski P, Cylke R, Lisik W, Trzebicki J. Comparison between Multimodal and Intraoperative Opioid Free Anesthesia for Laparoscopic Sleeve Gastrectomy: A Prospective, Randomized Study. Sci Rep. 2023;13:12677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZiemann-Gimmel P, Goldfarb AA, Koppman J, Marema RT. Opioid-Free Total Intravenous Anaesthesia Reduces Postoperative Nausea and Vomiting in Bariatric Surgery beyond Triple Prophylaxis. Br J Anaesth. 2014;112:906\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClanet M, Touihri K, El Haddad C, Goldsztejn N, Himpens J, Fils JF, Gricourt Y, Van der Linden P, Coeckelenbergh S, Joosten A, et al. Effect of Opioid-Free versus Opioid-Based Strategies during Multimodal Anaesthesia on Postoperative Morphine Consumption after Bariatric Surgery: A Randomised Double-Blind Clinical Trial. BJA Open. 2024;9:100263.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAo Y, Ma J, Zheng X, Zeng J, Wei K. Opioid-Sparing Anesthesia Versus Opioid-Free Anesthesia for the Prevention of Postoperative Nausea and Vomiting after Laparoscopic Bariatric Surgery: A Systematic Review and Network Meta-Analysis. Analg: Anesth; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakata RK, de Lima RC, Valad.o JA, Leal PC, Moura EC, Cruz VP, de Oliveira CM. Randomized, Double-Blind Study of the Effect of Intraoperative Intravenous Lidocaine on the Opioid Consumption and Criteria for Hospital Discharge after Bariatric Surgery. Obes Surg. 2019;30:1189\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur M, Singh P. Current Role of Dexmedetomidine in Clinical Anesthesia and Intensive Care. Anesth Essays Res. 2011;5:128.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlbing S, Infanger L, Fleischmann E, Prager G, Hamp T. The Performance of Opioid-Free Anesthesia for Bariatric Surgery in Clinical Practice. Obes Surg. 2023;33:1687\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHung K-C, Chiu C-C, Hsu C-W, Lin C-M, Liao S-W, Teng I-C, Chen I-W, Sun C-K. Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: A Meta-Analysis of Randomized Controlled Studies. Obes Surg. 2022;32:3113\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenck JT, Ten\u0026oacute;rio SB, de Oliveira RM, Strobel R, dos Santos BB, Junior AF, de Cesaro MP. Opioid-Free Anesthesia for Laparoscopic Gastroplasty. A Prospective and Randomized Trial. Open Anesth J. 2022;16:e258964582208110.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"morbid obesity, anesthesia, opioids, bariatric surgery, metabolic surgery, postoperative pain, PONV","lastPublishedDoi":"10.21203/rs.3.rs-8269644/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8269644/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBariatric surgery is considered the most effective treatment for morbid obesity, but perioperative pain control and the prevention of postoperative nausea and vomiting (PONV) remain major clinical challenges. Traditional opioid-based anesthesia (OBA) is effective for antinociception but associated with adverse effects, prompting increasing interest in opioid-free anesthesia (OFA).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this prospective, randomized study, 60 patients undergoing laparoscopic bariatric surgery were allocated to receive either OBA (desflurane\u0026thinsp;+\u0026thinsp;remifentanil, with postoperative multimodal analgesia including morphine) or OFA (desflurane\u0026thinsp;+\u0026thinsp;dexmedetomidine, lidocaine, ketamine, and opioid-free multimodal postoperative analgesia). Primary outcomes included postoperative pain (Numerical Rating Scale, NRS) and need for rescue analgesia. Secondary outcomes were intraoperative nociception (NOL index), incidence of PONV, and patient satisfaction.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe OFA group showed significantly lower pain scores at PACU discharge (p\u0026thinsp;=\u0026thinsp;0.004), within the first 24 hours (p\u0026thinsp;=\u0026thinsp;0.035), and at hospital discharge (p\u0026thinsp;=\u0026thinsp;0.023), as well as a reduced need for rescue analgesia (p\u0026thinsp;=\u0026thinsp;0.002). NOL monitoring suggested improved intraoperative nociception control with OFA. No significant differences were found in PONV incidence between groups. Patient satisfaction was high in both groups, with a non-significant trend favoring OFA. No major perioperative complications were observed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOpioid-free anesthesia demonstrated superiority over opioid-based techniques in reducing postoperative pain and rescue analgesia requirements in bariatric surgery, without increasing adverse events. These findings support OFA as a safe and effective strategy, warranting larger multicenter trials to validate its clinical benefits and long-term impact.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNCT Number: NCT07337135. Registered on 13th January 2026. 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