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A Multimodal Analgesic Protocol Reduces Opioid-Related Adverse Events and Improves Patient Outcomes in Laparoscopic Sleeve Gastrectomy

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed procedures for the treatment of obesity. Patients with obesity are more prone to experience opioid-related adverse events (ORAE).

Objectives

The objective of this study is to determine if a multimodal analgesia protocol (MAP) reduces ORAE and provides effective pain relief for patients after LSG.

Setting

This study was conducted at University Hospital, Singapore.

Methods

The MAP consists of mandatory pre-operative etoricoxib, intra-operative acetaminophen, and post-operative acetaminophen with optional post-operative tramadol. We identified and collected data for patients who underwent LSG between May 2010 and November 2015 and compared patients before and after the implementation of the MAP.

Results

One hundred fifty-eight patients were included and 68 patients were treated with the MAP. There were no differences in age, gender, body mass index, ethnicity, or comorbidities between the two groups except for the incidence of hypertension (p = 0.015). There was a significant reduction in the incidence of ORAE from 33.3 to 8.8% (p < 0.001) after the implementation of the MAP. There was also a significant reduction in the use of opioids intra-operatively from 58.2 to 43.6 mg (p < 0.001) and post-operatively from 23.7 to 0.7 mg (p < 0.001). Pain scores were similar at 1, 6, and 48 post-operatively, while pain scores were significantly reduced at 12 (p = 0.033) and 24 h (p = 0.02) post-operatively. Multivariate analysis showed that these results remained significant.

Conclusion

Our study suggests that a MAP reduces ORAE and provides effective pain relief for patients undergoing LSG.

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Author information

Authors and Affiliations

  1. Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Jun Jie Ng, Davide Lomanto, Jimmy B. Y. So & Asim Shabbir

  2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Wei Qi Leong

  3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Chuen Seng Tan

  4. Department of Anaesthesia, National University of Singapore, Singapore, Singapore

    Keah How Poon

Authors
  1. Jun Jie Ng
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  2. Wei Qi Leong
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  3. Chuen Seng Tan
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  4. Keah How Poon
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  5. Davide Lomanto
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  6. Jimmy B. Y. So
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  7. Asim Shabbir
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Corresponding author

Correspondence to Asim Shabbir.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding

This study was not funded by any institution or individual.

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Ng, J.J., Leong, W.Q., Tan, C.S. et al. A Multimodal Analgesic Protocol Reduces Opioid-Related Adverse Events and Improves Patient Outcomes in Laparoscopic Sleeve Gastrectomy. OBES SURG 27, 3075–3081 (2017). https://doi.org/10.1007/s11695-017-2790-7

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  • DOI: https://doi.org/10.1007/s11695-017-2790-7

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