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Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery

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Abstract

Background

Postoperative pain and analgesia present challenges in bariatric surgery patients. Multimodal analgesia may provide better efficacy, less complications and expedite fast-track bariatric surgical care. There are no studies of the broader topic of perioperative analgesia and the overall impact. This study highlights the impact of multimodal intraoperative analgesia on fast-track bariatric surgery.

Methods

This observational study examined the perioperative outcome data of 412 consecutive laparoscopic bariatric surgery patients over a 6-year period. Perioperative outcome and variables were analysed and compared between different intraoperative analgesia types.

Results

Mean BMI was 49, mean age was 42 and male:female ratio was 1:4. About 82% of patients received multimodal intraoperative analgesia, comprising various combinations of bupivacaine infiltration and intravenous acetaminophen, morphine, tramadol, parecoxib or diclofenac. Morphine was administered in 83% of patients and tramadol in 17%. Multimodal intraoperative analgesia provided better postoperative analgesia, shorter postanaesthesia care unit (PACU) duration, lower postoperative opioid requirement, less postoperative vomiting, earlier postoperative oral intake, earlier ambulation and shorter hospital stay compared to unimodal intraoperative morphine analgesia (p = 0.0001). Multimodal analgesia comprising tramadol + acetaminophen + diclofenac provided better postoperative analgesia, shorter PACU duration, lower postoperative opioid requirement, earlier ambulation, shorter hospital stay and less postoperative hypopnoea compared to patients who received morphine (p = 0.0001).

Conclusions

Multimodal intraoperative analgesia provides better postoperative analgesia, less complications and better perioperative outcomes and facilitates fast-track bariatric surgical care. Tramadol is suitable, efficacious and safe and associated with the best perioperative outcomes in bariatric surgery patients.

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Acknowledgements

This study was approved and registered by the research department of Central Manchester University Hospital, Manchester, UK.

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Authors and Affiliations

  1. Department of Anaesthesia, University of British Columbia, Vancouver, BC, Canada

    Olumuyiwa A. Bamgbade

  2. Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada

    Oluwafemi Oluwole

  3. Department of Surgery, University of Manchester, Manchester, UK

    Rong R. Khaw

Authors
  1. Olumuyiwa A. Bamgbade
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  2. Oluwafemi Oluwole
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  3. Rong R. Khaw
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Corresponding author

Correspondence to Olumuyiwa A. Bamgbade.

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Conflict of Interest

Institutional support is acknowledged, but there was no conflict of interest or financial involvement regarding any of the authors. The first author has no conflict of interest. The second author has no conflict of interest. The third author has no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bamgbade, O.A., Oluwole, O. & Khaw, R.R. Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery. OBES SURG 27, 1828–1834 (2017). https://doi.org/10.1007/s11695-017-2562-4

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  • DOI: https://doi.org/10.1007/s11695-017-2562-4

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