Does the postoperative analgesia affect morbidity in bariatric surgery? A single-centre retrospective review.

BACKGROUND AND GOAL OF STUDY: Uneventful postoperative recovery in morbidly obese patients undergoing bariatric surgery may offer challenges to anesthesiologists. This study aimed to investigate a possible relationship between different acute-pain analgesic therapies and postoperative morbidity and mortality in bariatric surgery.  

MATERIALS AND METHODS: This was a retrospective observational study of patients (n = 60) who underwent laparoscopic sleeve gastrectomy following a protocol from 2014 to august 2015. The subjects were classified into 4 groups according to different analgesic therapies for acute postoperative pain: GROUP A -intravenous morphine infussion (1.5 mg/h; n = 18); GROUP B - intravenous tramadol (100 mg every 8 hours; n = 14); GROUP C - intravenous NSAIDs (dexketoprofen 50 mg every 8 hours; n = 13) or  GROUP D - epidural fentanyl/levobupivacaine infusion (fentanyl 2 mcg/ml; levobupivacaine 0.125%; 8 ml/h; n = 15). The following parameters were recorded: demographic characteristics, Body Mass Index (BMI), ASA physical status classification system, postoperative complications, URPA stay, ICU stay and total hospital stay. The study was carried out after the approval of the Hospital Ethic Committe. The data were analyzed with 95% confidence by SPSS20, using descriptive and analytic statistics (Fisher's Exact Test, Kruskall-Wallis Test).

RESULTS AND DISCUSSION: A total of 60 laparoscopic sleeve gastrectomies were performed.  Morbid obesity prevalence in the sample was higher in women (65%). However, groups can be considered demographically homogeneous. With regard to hospital length of stay (URPA stay, ICU stay and total hospital stay) there were no statistically significant differences among analgesic therapies (p1 = 0.161; p2 = 0.194; p3 = 0.367).  The incidence of postoperative nausea or vomiting was higher in intravenous-opioid therapies (11% tramadol; 16% morphine). Two cases of gastrointestinal perforation (1 in group A who finally died, 1 in group D), two events of haemoperitoneum (1 in group A, 1 in group B) and one episode of intra-abdominal abscess (group D) were described in the sample. 

CONCLUSION: The optimal acute-pain analgesic treatment after bariatric surgery remains unclear. None of these therapies has shown to increase morbidity, mortality or length of hospital stay in the sample. Therefore, it is a multiple-choice question with several correct answers. Nevertheless, we need a larger sample size to gain power and obtain new conclusions. The integration of multimodal analgesia techniques with a multidisciplinary rehabilitation program in bariatric surgery may enhance recovery, reduce hospital stay, and facilitate early convalescence.