Multimodal Postoperative Pain Control Is Effective and Reduces Opioid Use After Laparoscopic Roux-en-Y Gastric Bypass.
Acetaminophen
/ administration & dosage
Administration, Oral
Adult
Aged
Analgesics, Opioid
/ administration & dosage
Breakthrough Pain
/ drug therapy
Celecoxib
/ administration & dosage
Dose-Response Relationship, Drug
Drug Therapy, Combination
/ methods
Female
Gastric Bypass
/ adverse effects
Humans
Laparoscopy
/ adverse effects
Male
Middle Aged
Obesity, Morbid
/ epidemiology
Opioid-Related Disorders
/ epidemiology
Pain Management
/ methods
Pain Measurement
Pain, Postoperative
/ therapy
Postoperative Period
Retrospective Studies
Treatment Outcome
Acetaminophen
Bariatric surgery
Celecoxib
Multimodal pain control
Opioid
Journal
Obesity surgery
ISSN: 1708-0428
Titre abrégé: Obes Surg
Pays: United States
ID NLM: 9106714
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
pubmed:
15
10
2018
medline:
31
12
2019
entrez:
15
10
2018
Statut:
ppublish
Résumé
Opioids have been the mainstay for postoperative pain relief for many decades. Recently, opioid-related adverse events and death have been linked to postoperative dependency. Multimodal approaches to postoperative pain control may be part of the solution to this health care crisis. The safety and effectiveness of multimodal pain control regimens after laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been well studied. The primary aim of our study was to determine if an evidence-based, multimodal pain regimen during hospitalization could decrease the total oral morphine equivalent (TME) use after LRYGB. We conducted a retrospective cohort study comparing outcomes prior to the implementation of a multimodal pain protocol (December 2010-December 2012) to those after implementation (April 2013-July 2015). The protocol utilized oral celecoxib and scheduled oral acetaminophen for pain control, with opioids used only as needed for breakthrough pain. Data was extracted from an electronic medical record and an institutionally maintained database of all patients undergoing bariatric surgery at a single center. Compared to controls, the multimodal pain regimen significantly reduced TME used and maximum pain scores with no change in mean pain scores. Multimodal pain protocol patients had a shorter length of stay with no increase in bleeding complications or marginal ulcer rates. An opioid-sparing multimodal pain regimen adequately controls pain while reducing TME use. The regimen appears to be safe and was associated with a reduced length of stay in patients undergoing LRYGB.
Sections du résumé
BACKGROUND
Opioids have been the mainstay for postoperative pain relief for many decades. Recently, opioid-related adverse events and death have been linked to postoperative dependency. Multimodal approaches to postoperative pain control may be part of the solution to this health care crisis. The safety and effectiveness of multimodal pain control regimens after laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been well studied. The primary aim of our study was to determine if an evidence-based, multimodal pain regimen during hospitalization could decrease the total oral morphine equivalent (TME) use after LRYGB.
STUDY DESIGN
We conducted a retrospective cohort study comparing outcomes prior to the implementation of a multimodal pain protocol (December 2010-December 2012) to those after implementation (April 2013-July 2015). The protocol utilized oral celecoxib and scheduled oral acetaminophen for pain control, with opioids used only as needed for breakthrough pain. Data was extracted from an electronic medical record and an institutionally maintained database of all patients undergoing bariatric surgery at a single center.
RESULTS
Compared to controls, the multimodal pain regimen significantly reduced TME used and maximum pain scores with no change in mean pain scores. Multimodal pain protocol patients had a shorter length of stay with no increase in bleeding complications or marginal ulcer rates.
CONCLUSIONS
An opioid-sparing multimodal pain regimen adequately controls pain while reducing TME use. The regimen appears to be safe and was associated with a reduced length of stay in patients undergoing LRYGB.
Identifiants
pubmed: 30317488
doi: 10.1007/s11695-018-3526-z
pii: 10.1007/s11695-018-3526-z
doi:
Substances chimiques
Analgesics, Opioid
0
Acetaminophen
362O9ITL9D
Celecoxib
JCX84Q7J1L
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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