Brian Hoyle

The implementation of an evidence-based, multimodal pain regimen after Roux-en-Y gastric bypass (LRYGB) was associated with a significant decrease in narcotic requirements as well as maximum postoperative pain scores, according to a study presented here on November 1 at Obesity Week 2016, the Annual Meetings of the American Society for Metabolic & Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

Ryan Horsley, DO, Geisinger Medical Center, Danville, Pennsylvania, and colleagues conducted the study to explore whether the pre-determined use of pain medication before and after LRYGB could cut down on morphine use, length of hospital stay, and pain suffered.

The study included 629 patients undergoing LRYGB. On the day of surgery, patients received celecoxib 400 mg and acetaminophen 975 mg. In the first 24 hours after surgery, patients could self-administer a narcotic analgesic and could receive celecoxib 400 mg and acetaminophen 975 mg every 8 hours, acetaminophen 650 mg for breakthrough pain with a limit of 4,000 mg/day, and oral oxycodone as needed for pain that was severe. The acetaminophen and oxycodone use was continued through day 3.

The pain regimen had been in effect at the centre since mid-2013. The retrospective study involved 384 patients treated prior to the introduction of the regimen and 245 patients treated from the time of introduction of the regimen to July 2015.

The 2 groups were comparable in age, gender, body mass index at baseline and the time of surgery, Charlson comorbidity score, and length of surgery.

Univariate analysis of outcomes revealed significantly shorter hospital length of stay for those treated with the multimodal pain relief regimen (1.8 ± 1.0 vs 1.5 ± 0.71 days; P < .0001). Other outcomes were comparable and included 30- and 90-day, ventilator use, acute kidney injury, reoperation, and readmission.

Univariate analysis also revealed less morphine use in terms of mean morphine equivalent units following implementation of the pain regimen (225.2 ± 302.5 for pre-intervention, 163.4 ± 221.4 for post-intervention; P = .0059). The 2 groups were similar in terms of mean post-operative pain scores, but the severity of pain was less for those patients receiving the pain relief regimen (maximum pain score on a 10-point Likert scale: 7.7 ± 1.9 for pre-intervention, 7.1 ± 2.4 for post-intervention; P = .0011).

Weight loss in the 6 months following surgery was comparable before and after the pain regimen implementation.

The researchers opined that the regimen could enhance recovery following LRYGB.

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