Reduced Postoperative Pain and Complications after a Modified Multidisciplinary Approach for Bariatric Surgery



Rachel A. Karlnoski1, 2, Collin Sprenker B.S1, Suvikram Puri3, Ren Chen4, Devanand Mangar1, Michel M. Murr2, Enrico M. Camporesi1, 2, *
1 Florida Gulf to Bay Anesthesiology, Tampa General Hospital, Tampa, FL, USA
2 Department of Surgery, University of South Florida, Tampa, FL, USA
3 Georgia Health Sciences University, Augusta, Georgia, USA
4 Biostatistics Core, University of South Florida, Tampa, FL, USA


© 2013 Karlnoski et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University of South Florida College of Medicine, 1 Tampa General Circle, Suite A327, Tampa, FL 33606, USA; Tel: 813.844.7170; Fax: 813.844.7580; E-mail: ecampore@health.usf.edu


Abstract

Background:

There are considerable implications for pain management in morbidly obese patients undergoing weight loss operations. The purpose of this study was to determine if a modified postoperative analgesic regimen and a dedicated postoperative bariatric team reduced pain scores, length of stay and postoperative complications.

Materials and Methods:

We performed a retrospective analysis of morbidly obese patients admitted to our medical center for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). Our previous postoperative pain regimen was ketorolac (30 mg IV plus 15 mg q6h) and patient controlled analgesia (PCA) morphine and was converted to ketorolac (30 mg IV and 30 mg i.m, plus 15 mg q6h), and IV PCA hydromorphone. Visual analog scale (VAS) pain scores from the post-operative care unit were collected retrospectively. The bariatric team was led by a nurse practitioner consisted of a psychologist, exercise physiologist, and nutritionist.

Results:

Eighty-five patients underwent bariatric operations in the year prior to implementation of the revised postoperative pain management regimen and 372 patients underwent bariatric surgery in the 2 years following implementation. Patient age, gender and BMI were evenly distributed for both groups. Mean VAS scores on postoperative days 1 through 5 were significantly lower after implanting our modified pain regimen (p<0.0001). Pain scores were significantly higher for patients that underwent LRYGB compared to LAGB (p<0.0001). Overall, length of hospital stay was unaffected by the new pain regimen, however a significant reduction was found in patients that underwent LAGB (0.8 days less; p=0.0001).

Conclusion:

Use of our modified pain regimen resulted in a more effective analgesic protocol and a reduction of hospital stay, without added complications or side effects.

Keywords: Analgesia, gastric banding, gastric bypass, hydromorphone, ketorolac, laparoscopic, Obesity, Roux-en-Y.