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Safety and Efficacy of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used for Analgesia After Bariatric Surgery: A Retrospective Case-Control Study

  • Hicham Abou ZeidEmail author
  • Rita Kallab
  • Marie Antoinette Najm
  • Hisham Jabbour
  • Roger Noun
  • Fadi Sleilati
  • Salim Chucri
  • Christine Dagher
  • Ghassan Sleilaty
  • Nicole Naccache
Original Contributions

Abstract

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are cornerstone in multimodal analgesia protocols. This point is of great value in morbidly obese patients due to the high prevalence of restrictive pulmonary disease and obstructive sleep apnea. The aim of this study was to test the hypothesis that NSAIDs do not increase acute bariatric surgery complications while optimizing postoperative analgesia.

Methods

Databases of two medical centers were retrospectively reviewed to find all patients who underwent bariatric surgery between 1 January 2017 and 31 December 2017. Inclusion criteria were BMI greater than 30 kg/m2 and age of 16–75 years old. Patients who suffered from severe organ failure or coagulation disorders were excluded. Patient’s demographics, obesity-related diseases (diabetes, hypertension, dyslipidemia), postoperative pain scores, and morphine consumption in PACU, as well as early and late surgical complications, were collected. Patients included from the first institution (where NSAIDs analgesia was prohibited: control group) were compared to patients from the second institution (where NSAIDs analgesia was mandatory: case group).

Results

The study population included 270 patients, 134 in the control group, and 136 in the case group. NSAIDs usage produced better analgesia with significant reduction in morphine consumption and PACU length of stay. Also, incidence of surgical complications was the same in the two groups.

Conclusions

NSAIDs administration do not increase postoperative complication rate after bariatric surgery. Although NSAID administration provided better analgesia and shorter PACU stay, future prospective studies are needed to confirm these encouraging results and to evaluate their impact on postoperative rehabilitation.

Keywords

Bariatric surgery NSAIDs Multimodal analgesia Postoperative complications Anastomosis leak Bleeding 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

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

References

  1. 1.
    Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin N Am. 2016;45(4):571–9.CrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292(14):1724–37.CrossRefGoogle Scholar
  3. 3.
    Hernandez J, Boza C. Novel treatments for complications after bariatric surgery. Ann Surg Innov Res. 2016;10:3.CrossRefGoogle Scholar
  4. 4.
    Govindarajan R, Ghosh B, Sathyamoorthy MK, et al. Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity. Surg Obes Relat Dis. 2005;1(6):530–5. discussion 535-6CrossRefGoogle Scholar
  5. 5.
    McDaid C et al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess. 2010;14(17):1–153. iii-ivCrossRefGoogle Scholar
  6. 6.
    Whistance RN, Forsythe RO, McNair AGK, et al. A systematic review of outcome reporting in colorectal cancer surgery. Color Dis. 2013;15(10):e548–60.CrossRefGoogle Scholar
  7. 7.
    Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006;332(7553):1302–8.CrossRefGoogle Scholar
  8. 8.
    Coblijn UK, Lagarde SM, de Castro SMM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25(5):805–11.CrossRefGoogle Scholar
  9. 9.
    Sverden E et al. Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg. 2016;263(4):733–7.CrossRefGoogle Scholar
  10. 10.
    Warner TD, Giuliano F, Vojnovic I, et al. Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci U S A. 1999;96(13):7563–8.CrossRefGoogle Scholar
  11. 11.
    Collaborative ST. Impact of postoperative non-steroidal anti-inflammatory drugs on adverse events after gastrointestinal surgery. Br J Surg. 2014;101(11):1413–23.CrossRefGoogle Scholar
  12. 12.
    Marret E, Kurdi O, Zufferey P, et al. Effects of nonsteroidal antiinflammatory drugs on patientcontrolled analgesia morphine side effects: metaanalysis of randomized controlled trials. Anesthesiology. 2005;102:1249–60.CrossRefGoogle Scholar
  13. 13.
    Xinyu Zhang PTD, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrology. 2017;18:256.CrossRefGoogle Scholar
  14. 14.
    Curiel RV, Katz JD. Mitigating the cardiovascular and renal effects of NSAIDs. Pain Med. 2013;14(Suppl 1):S23–8.CrossRefGoogle Scholar
  15. 15.
    Okamura A, Watanabe M, Imamura Y, et al. Preoperative glycosylated hemoglobin levels predict anastomotic leak after esophagectomy with cervical esophagogastric anastomosis. World J Surg. 2017;41(1):200–7.CrossRefGoogle Scholar
  16. 16.
    Ding N, Mao Y, He J, et al. Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer. J Thorac Dis. 2017;9(2):386–91.CrossRefGoogle Scholar
  17. 17.
    Vorwald P et al. Laparoscopic Roux-en-Y gastric bypass after open vertical banded gastroplasty in patient with severe GERD. Obes Surg. 2017:1–1.Google Scholar
  18. 18.
    Nguyen NT, Ho HS, Palmer LS, et al. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg. 2000;191(2):149–55. discussion 155-7CrossRefGoogle Scholar
  19. 19.
    White S, Han SH, Lewis C, et al. Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(2):122–5.CrossRefGoogle Scholar
  20. 20.
    Burton TP, M. A, Soop M. Nonsteroidal antiinflammatory drugs and anastomotic dehiscence in bowel surgery: systematic review and meta-analysis of randomized, controlled trials. Dis Colon Rectum. 2013;56:126–34.CrossRefGoogle Scholar
  21. 21.
    Gorissen KJ, B. D, Berghmans T, et al. Risk of anastomotic leakage with non-steroidal antiinflammatory drugs in colorectal surgery. Br J Surg. 2012;99:721–7.CrossRefGoogle Scholar
  22. 22.
    Ferraz AA, Cowles VE, Condon RE, et al. Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg. 1995;61(12):1079–83.PubMedGoogle Scholar
  23. 23.
    Lyons, M.M., et al. Symptomless multi-variable apnea prediction index assesses obstructive sleep apnea risk and adverse outcomes in elective surgery. Sleep, 2017 40(3).Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hicham Abou Zeid
    • 1
    • 2
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  • Rita Kallab
    • 1
  • Marie Antoinette Najm
    • 3
  • Hisham Jabbour
    • 1
  • Roger Noun
    • 4
  • Fadi Sleilati
    • 5
  • Salim Chucri
    • 6
  • Christine Dagher
    • 1
  • Ghassan Sleilaty
    • 7
  • Nicole Naccache
    • 1
  1. 1.Department of Anesthesia, Crtitical Care and Pain ManagementHôtel Dieu de France hospital, Saint Joseph university school of medicineBeirutLebanon
  2. 2.Hôtel Dieu de France HospitalBeirutLebanon
  3. 3.Department of AnesthesiaMonseigneur Cortbawi InstituteAdmaLebanon
  4. 4.Department of SurgeryHôtel Dieu de France hospital, Saint Joseph university school of medicineBeirutLebanon
  5. 5.Department of SurgeryMonseigneur Cortbawi InstituteAdmaLebanon
  6. 6.Department of PneumologyHôtel Dieu de France hospital, Saint Joseph university school of medicineBeirutLebanon
  7. 7.Department of StatisticsSaint Joseph university school of medicineBeirutLebanon

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