Efficacy and Safety of Patient-Controlled Analgesia for Morbidly Obese Patients Following Gastric Bypass Surgery

Choi, Young Don; Brolin, Robert E.; Wagner, Bertil K.J.; Chou, Stanley; Etesham, Soheil; Pollak, Phyllis

doi:10.1381/096089200321668703

Cited by 57 publications

(16 citation statements)

References 26 publications

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“…5) Continuous intravenous injection of morphine by patient-controlled analgesia (PCA) is often used in many countries and rated favorably. 6) Morphine is used to obtain a favorable analgesic eŠect for any dosing method, but it may increase the incidence of Postoperative nausea and vomiting (PONV) or make food intake di‹cult, which leads to the discontinuance of its administration. Such a PONV is a signiˆcant problem for patients after surgery since it decreases the patient's quality of life (QOL) and satisfaction with the treatment as a whole.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

et al. 2001

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Postoperative nausea and vomiting (PONV) with morphine therapy develops in more than 60％ of patients after surgery, markedly reducing patient QOL. The prophylactic eŠect of several antiemetics has already been studied, but evaluations, and even those using the same drug, are not uniform. The present research involved a meta-analysis of randomized controlled trials on prophylactic drug therapy for PONV in patients receiving morphine for the treatment of postoperative pain. The e‹cacy of the prophylactic administration of the drugs was examined.As a result, meta-analysis ofˆve drugs was possible and the evidence of e‹cacy was shown for three drugs ranked in order of an increasing odds ratio (OR) and conˆdence interval (CI): dexamethasone (OR: 0.23, 95％ CI: 0.15-0.35, p＜ 0.00001), droperidol (OR: 0.27, 95％ CI: 0.21-0.34, p＜0.00001), and metoclopramide (OR: 0.48, 95％ CI: 0.30-0.75, p＜0.001). These results suggest that the three drugs are eŠective in prophylactic treatment for PONV. Of them, dexamethasone used as a prophylactic drug for PONV provided the best results. Dexamethasone was shown to reduce the incidence of PONV from 66-80％ to 16-50％ with a dose of 1.25 to 10 mg and to be suitable as aˆrst drug of choice.

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Section: Introductionmentioning

confidence: 99%

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

et al. 2001

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“…Opioid use is problematic in obese patients: calculation of adequate doses is difficult using traditional body surface area measurements, given the disparity between lean and total body mass; obese patients are particularly susceptible to opioid-induced respiratory depression; and opioid use may exacerbate obstructive sleep apnea in affected patients [5,6]. These are the issues that dissuaded us from the routine postsurgical use of patient-controlled analgesia, which, combined with inadequate supervision during hospitalization, can result in excessive opioid use and increased risk of AEs in obese patients.…”

Section: Discussionmentioning

confidence: 99%

Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report

Bertin¹

2014

J Med Case Reports

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IntroductionTo reduce incidence and severity of postsurgical pain and minimize the effect of its clinical and economic correlates, multimodal therapy for surgical patients is recommended. In this report, we discuss the use of liposome bupivacaine, a novel multivesicular formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia, as part of a multimodal analgesic regimen in a patient with a history of chronic pain scheduled to undergo laparoscopic sleeve gastrectomy. To the best of our knowledge, this is the first published report of liposome bupivacaine in the setting of laparoscopic sleeve gastrectomy.Case presentationA 35-year-old white woman with morbid obesity was admitted for laparoscopic sleeve gastrectomy to lose weight prior to hip replacement surgery. Because of a complicated medical history that included rheumatoid arthritis, fibromyalgia, diabetes mellitus, hypertension, and chronic pain, for which she was receiving high doses of opioid analgesics, postsurgical pain management was a concern and she was considered a candidate for multimodal analgesia. At initiation of surgery, 50mL of lidocaine and epinephrine was infiltrated around the port sites. At the conclusion, 25mL of normal sterile saline was added to a 20mL vial of liposome bupivacaine (266mg) and injected around the port sites and at the site of liver retraction. Laparoscopic sleeve gastrectomy was successfully completed. Our patient was discharged to the postanesthesia care unit for approximately four hours before discharge to the surgical floor with a pain score of 5 (11-point scale; 0 = no pain, 10 = worst possible pain). Her postoperative course was uneventful; no adverse events were recorded during surgery or during the remainder of her hospital stay. Our patient was discharged on the same opioid regimen used previously for control of her preexisting chronic pain.ConclusionsLiposome bupivacaine use in this morbidly obese patient undergoing laparoscopic sleeve gastrectomy provided analgesic efficacy and limited postsurgical opioids to a level comparable with her baseline opioid regimen for chronic pain. Given her complex medical history and previous issues with acute and chronic pain, we consider these results highly successful and continue to use liposome bupivacaine as part of a multimodal analgesic regimen in an effort to optimize postsurgical pain management.

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“…Intramuscular injection of analgesic drugs is not recommended due to technical difficulties and unreliability in absorption [59][60][61] . Patient-controlled analgesia (PCA), essentially "on-demand" intravenous opioid analgesia, has been associated with greater patient satisfaction and lower pain scores as compared to other forms of parenteral opioid administration [17,62] .…”

Section: Postoperative Analgesiamentioning

confidence: 99%

Postoperative Care of the Obese Patient

Chong

Bell

2012

Critical Care Management of the Obese Patient

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Efficacy and Safety of Patient-Controlled Analgesia for Morbidly Obese Patients Following Gastric Bypass Surgery

Abstract: PCA is safe and effective for morbidly obese patients following RYGBP.

Cited by 57 publications

References 26 publications

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

Liposome bupivacaine for postsurgical pain in an obese woman with chronic pain undergoing laparoscopic gastrectomy: a case report

Postoperative Care of the Obese Patient

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