Evolving Anesthesia Strategies for Enhanced Recovery in Gastrectomy

Introduction: Gastrectomy, whether for bariatric weight loss or gastric cancer resection, demands precise anesthetic management due to the complexity of the procedure and patient physiology. With rising global obesity and persistent gastric malignancy rates, optimizing perioperative care through advanced anesthetic strategies is critical. Traditional opioid-based anesthesia is associated with delayed recovery and adverse effects, particularly in obese individuals. Consequently, interest has grown in opioid-free anesthesia (OFA), multimodal analgesia (MMA), and balanced techniques that minimize opioid use while enhancing recovery. Methodology: A systematic literature review was conducted using PubMed and Google Scholar databases per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Clinical trials and observational studies from January 2015 to June 2025 involving human subjects undergoing gastrectomy were included. Studies were screened and selected based on inclusion/exclusion criteria and methodological quality using a scale for the assessment of narrative review articles (SANRA) scores. Four high-quality studies were included for final analysis. Results: OFA significantly improved early postoperative recovery (Quality of recovery-40 (QoR-40 scores)), reduced opioid consumption, and enabled earlier oral intake and discharge readiness. Balanced anesthesia using propofol-etomidate offered better hemodynamic stability and faster cognitive recovery than individual agents. Sevoflurane-based anesthesia reduced neuromuscular blocker requirements and post-anesthesia care unit (PACU) stay duration. Gabapentin premedication delayed opioid initiation and reduced 12-hour oxycodone use without increasing adverse effects. Conclusion: Opioid-sparing strategies like OFA, balanced anesthesia, and gabapentin premedication enhance perioperative outcomes in gastrectomy. These approaches support individualized anesthetic protocols to optimize recovery and minimize complications, though larger trials are needed to confirm efficacy and guide standardization.