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Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia)

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Abstract

Introduction

Although bariatric surgery is actually mainly performed laparoscopically, analgesic optimization continues being essential to reduce complications and to improve the patients’ comfort. The aim of this study is to evaluate the postoperative pain after analgesia iv exclusively, or associated with epidural analgesia or port-sites infiltration with bupivacaine.

Patients and methods

A prospective randomized study of patients undergoing laparoscopic sleeve gastrectomy between 2012 and 2014 was performed. Patients were divided into three groups: Analgesia iv exclusively (Group 1), epidural analgesia + analgesia iv (Group 2) and port-sites infiltration + analgesia iv (Group 3). Pain was quantified by means of a Visual Analogic Scale, and morphine rescue needs were determined 24 h after surgery.

Results

A total of 147 were included. Groups were comparable in age, gender and BMI. There were no differences in operation time, complications, mortality or hospital stay between groups. Median pain 24 h after surgery was 5 in Group 1, 2.5 in Group 2 and 2 in Group 3 (P = 0.01), without statistically significant differences between Groups 2 and 3. In Group 1, morphine rescue was necessary in 16.3 % of the cases, 2 % in Group 2 and 2 % in Group 3 (P = 0.014), without statistically significant differences between Groups 2 and 3.

Conclusion

Epidural analgesia and port-sites infiltration with bupivacaine, associated with analgesia iv, reduce the postoperative pain, when compared with analgesia iv exclusively.

Clinical trials

ClinicalTrials.gov Identifier: NCT02662660.

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Authors and Affiliations

  1. Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain

    Jaime Ruiz-Tovar, Juan Gonzalez, Alejandro García, Montiel Jimenez, Carlos Ferrigni & Manuel Durán

  2. Department of Anaesthesiology, Bariatric Surgery Unit, University Hospital Elche, Alicante, Spain

    Jose Luis Muñoz

  3. Department of Surgery, Bariatric Surgery Unit, University Hospital Elche, Alicante, Spain

    Lorea Zubiaga

Authors
  1. Jaime Ruiz-Tovar
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  2. Jose Luis Muñoz
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  3. Juan Gonzalez
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  4. Lorea Zubiaga
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  5. Alejandro García
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  6. Montiel Jimenez
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  7. Carlos Ferrigni
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  8. Manuel Durán
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Corresponding author

Correspondence to Jaime Ruiz-Tovar.

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Disclosures

Jaime Ruiz-Tovar, MD, PhD; Jose Luis Muñoz, MD, PhD; Juan Gonzalez, MD; Lorea Zubiaga, MD, PhD; Alejandro García, MD, PhD; Carlos Ferrigni, MD; Montiel Jimenez, MD, and Manuel Durán, MD, PhD, have no conflicts of interest or financial ties to disclose.

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Ruiz-Tovar, J., Muñoz, J.L., Gonzalez, J. et al. Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia). Surg Endosc 31, 231–236 (2017). https://doi.org/10.1007/s00464-016-4961-3

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  • DOI: https://doi.org/10.1007/s00464-016-4961-3

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