Jun Jie Ng1, Wei Qi Leong2, Chuen Seng Tan3, Keah How Poon4, Davide Lomanto1, Jimmy B Y So1, Asim Shabbir5. 1. Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore. 2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. 4. Department of Anaesthesia, National University of Singapore, Singapore, Singapore. 5. Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore. cfsasim@nus.edu.sg.
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.
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.
Authors: Stephen E Daniels; Donald P Bandy; Steven E Christensen; Judith Boice; Maria C Losada; Hui Liu; Anish Mehta; Paul M Peloso Journal: Clin J Pain Date: 2011-01 Impact factor: 3.442
Authors: Shireesh Saurabh; Jessica K Smith; Mark Pedersen; Paul Jose; Peter Nau; Isaac Samuel Journal: Surg Obes Relat Dis Date: 2014-09-30 Impact factor: 4.734
Authors: Matthew A Strode; William Sherman; Chris W Mangieri; Christopher M Bland; Preston J Sparks; Byron J Faler; Balakrishna M Prasad; Yong U Choi Journal: Surg Obes Relat Dis Date: 2015-08-29 Impact factor: 4.734
Authors: Bahadır Ciftci; Mursel Ekinci; Erkan Cem Celik; Ahmet Kaciroglu; Muhammet Ahmet Karakaya; Yavuz Demiraran; Yasar Ozdenkaya Journal: Obes Surg Date: 2019-03 Impact factor: 4.129
Authors: Nicola Di Lorenzo; Stavros A Antoniou; Rachel L Batterham; Luca Busetto; Daniela Godoroja; Angelo Iossa; Francesco M Carrano; Ferdinando Agresta; Isaias Alarçon; Carmil Azran; Nicole Bouvy; Carmen Balaguè Ponz; Maura Buza; Catalin Copaescu; Maurizio De Luca; Dror Dicker; Angelo Di Vincenzo; Daniel M Felsenreich; Nader K Francis; Martin Fried; Berta Gonzalo Prats; David Goitein; Jason C G Halford; Jitka Herlesova; Marina Kalogridaki; Hans Ket; Salvador Morales-Conde; Giacomo Piatto; Gerhard Prager; Suzanne Pruijssers; Andrea Pucci; Shlomi Rayman; Eugenia Romano; Sergi Sanchez-Cordero; Ramon Vilallonga; Gianfranco Silecchia Journal: Surg Endosc Date: 2020-04-23 Impact factor: 4.584