{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:04:58Z","timestamp":1783929898275,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":193,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anesthesiology Research and Practice"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Laparoscopic bariatric surgery is associated with specific analgesic challenges because opioid\u2010related adverse effects may be especially relevant in patients with obesity, obstructive sleep apnea, and cardiometabolic comorbidities. Inadequate perioperative analgesia in this population may impair early mobilization and functional recovery, while excessive opioid use increases the risk of respiratory depression, postoperative nausea and vomiting (PONV), and prolonged hospital stay. This narrative review synthesizes and critically appraises contemporary evidence on intravenous lidocaine, dexmedetomidine, opioid\u2010free or opioid\u2010sparing anesthesia, and enhanced recovery after surgery (ERAS)\u2013based perioperative strategies in adult patients undergoing laparoscopic bariatric surgery. A structured literature search was conducted in PubMed\/MEDLINE, Embase, Scopus, and the Cochrane Library from January 2018 to May 2026. A total of 41 studies were included, comprising randomized controlled trials, observational studies, pharmacokinetic investigations, systematic reviews, meta\u2010analyses, and ERAS implementation studies. Methodological quality was appraised using RoB 2.0, ROBINS\u2010I, and AMSTAR\u20102 according to study design. Evidence for intravenous lidocaine remains heterogeneous and appears dependent on dosing strategy, infusion duration, and perioperative context; its antiemetic and anti\u2010inflammatory effects may be more consistent than its analgesic benefit when infusion is limited to the intraoperative period. Dexmedetomidine has been associated with reductions in perioperative opioid exposure and PONV through alpha\u20102\u2010mediated sympatholysis and opioid\u2010sparing mechanisms, although effects on pain scores are variable and hemodynamic monitoring is required. Opioid\u2010free or opioid\u2010sparing strategies may reduce opioid exposure and PONV, but superiority over conventional anesthesia for pain control or length of stay is inconsistent, and protocol heterogeneity limits generalizability. ERAS pathways represent the most comprehensive and evidence\u2010supported framework for perioperative optimization, with benefit proportional to adherence and independent of any single pharmacologic agent. These pharmacologic strategies are best understood as mechanism\u2010based adjuncts to be selectively integrated within high\u2010adherence ERAS programs, not as universal standalone interventions. Rigorous multicenter randomized trials with standardized dosing, detailed ERAS adherence reporting, patient\u2010centered outcome measures, and subgroup analyses by procedure type, OSA status, and PONV risk are needed.<\/jats:p>","DOI":"10.1155\/anrp\/6019290","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T07:05:01Z","timestamp":1783926301000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacological Modulation of Perioperative Pain in Laparoscopic Bariatric Surgery: An Updated Evidence\u2010Based Narrative Review of Intravenous Lidocaine, Dexmedetomidine, Opioid\u2010Free and Opioid\u2010Sparing Anesthesia, and ERAS\u2010Based 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