Postoperative pain management in obese patients undergoing gastric bypass surgery, Ketorolac and Morphine combination compared to Morphine administration effects: A Randomized Controlled Trial

Abstract

Background: Obstructive Sleep Apnea (OSA) is the most common respiratory problem in obese patients with Body Mass Index (BMI) > 30. Although narcotics are the best choice for postoperative pain management, their side effects restrict their utilization in these patients. Therefore, postoperative pain management remains a challenge in morbidly obese patients to reduce narcotic administration and prevent OSA. Methods: 70 obese patients with BMI > 40kg/m2 and BMI > 35kg/m2 with underlying diseases such as diabetes, hypertension, renal disease, and cardiovascular diseases, with American Society of Anesthesiologists (ASA) physical status 1 and 2 were enrolled in this clinical trial. Patients who underwent elective laparoscopic Reux-en Y bypass were divided into two groups. Group K received a Patient-Controlled Analgesia (PCA) infusion of Morphine, Paracetamol, and IM Ketorolac. Group M received a PCA infusion of Morphine, and Paracetamol. Patients’ pain scores were recorded using a visual analog scale (VAS) immediately after the surgery, 6, 12, 24 hours later, and upon discharge. Results: 64 patients completed the study. Pain scores decreased after the surgery, 6, 12, 24 hours later, and at the time of discharge (5.009±1.7, 3.191±2.21, 2.731±2.82, 2.106±1.48, 1.431±1.25, p<0.001) the mean of the pain score in the group K was significantly different from the group M which received Morphine, at all checkpoints ( 1.7 ± 0.34, p < 0.001). Conclusion: Ketorolac added to the Morphine infusion pump was more effective than the morphine regime in reducing postoperative pain in obese patients.