PMID- 28674840
OWN - NLM
STAT- MEDLINE
DCOM- 20180430
LR  - 20181202
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 27
IP  - 12
DP  - 2017 Dec
TI  - A Multimodal Analgesic Protocol Reduces Opioid-Related Adverse Events and 
      Improves Patient Outcomes in Laparoscopic Sleeve Gastrectomy.
PG  - 3075-3081
LID - 10.1007/s11695-017-2790-7 [doi]
AB  - BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly 
      performed procedures for the treatment of obesity. Patients with obesity are more 
      prone to experience opioid-related adverse events (ORAE). OBJECTIVES: The 
      objective of this study is to determine if a multimodal analgesia protocol (MAP) 
      reduces ORAE and provides effective pain relief for patients after LSG. SETTING: 
      This study was conducted at University Hospital, Singapore. METHODS: The MAP 
      consists of mandatory pre-operative etoricoxib, intra-operative acetaminophen, 
      and post-operative acetaminophen with optional post-operative tramadol. We 
      identified and collected data for patients who underwent LSG between May 2010 and 
      November 2015 and compared patients before and after the implementation of the 
      MAP. RESULTS: One hundred fifty-eight patients were included and 68 patients were 
      treated with the MAP. There were no differences in age, gender, body mass index, 
      ethnicity, or comorbidities between the two groups except for the incidence of 
      hypertension (p = 0.015). There was a significant reduction in the incidence of 
      ORAE from 33.3 to 8.8% (p < 0.001) after the implementation of the MAP. There was 
      also a significant reduction in the use of opioids intra-operatively from 58.2 to 
      43.6 mg (p < 0.001) and post-operatively from 23.7 to 0.7 mg (p < 0.001). Pain 
      scores were similar at 1, 6, and 48 post-operatively, while pain scores were 
      significantly reduced at 12 (p = 0.033) and 24 h (p = 0.02) post-operatively. 
      Multivariate analysis showed that these results remained significant. CONCLUSION: 
      Our study suggests that a MAP reduces ORAE and provides effective pain relief for 
      patients undergoing LSG.
FAU - Ng, Jun Jie
AU  - Ng JJ
AD  - Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 
      1E Kent Ridge Road, Singapore, 119228, Singapore.
FAU - Leong, Wei Qi
AU  - Leong WQ
AD  - Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 
      Singapore.
FAU - Tan, Chuen Seng
AU  - Tan CS
AD  - Saw Swee Hock School of Public Health, National University of Singapore, 
      Singapore, Singapore.
FAU - Poon, Keah How
AU  - Poon KH
AD  - Department of Anaesthesia, National University of Singapore, Singapore, 
      Singapore.
FAU - Lomanto, Davide
AU  - Lomanto D
AD  - Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 
      1E Kent Ridge Road, Singapore, 119228, Singapore.
FAU - So, Jimmy B Y
AU  - So JBY
AD  - Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 
      1E Kent Ridge Road, Singapore, 119228, Singapore.
FAU - Shabbir, Asim
AU  - Shabbir A
AD  - Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 
      1E Kent Ridge Road, Singapore, 119228, Singapore. cfsasim@nus.edu.sg.
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
RN  - 0 (Analgesics)
RN  - 0 (Analgesics, Opioid)
SB  - IM
CIN - Obes Surg. 2018 May;28(5):1417. PMID: 29492751
CIN - Obes Surg. 2018 May;28(5):1418. PMID: 29600338
MH  - Adult
MH  - Analgesia/adverse effects/economics/*methods
MH  - Analgesics/economics/*therapeutic use
MH  - Analgesics, Opioid/*adverse effects
MH  - Body Mass Index
MH  - Drug Costs
MH  - Female
MH  - *Gastrectomy/adverse effects/methods
MH  - Humans
MH  - Laparoscopy/adverse effects/methods
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/epidemiology/*surgery
MH  - Pain, Postoperative/economics/epidemiology/etiology/*prevention & control
MH  - Postoperative Complications/epidemiology/etiology/prevention & control
MH  - Postoperative Period
MH  - Singapore/epidemiology
OTO - NOTNLM
OT  - Analgesia
OT  - Enhanced recovery
OT  - Laparoscopic sleeve gastrectomy
EDAT- 2017/07/05 06:00
MHDA- 2018/05/01 06:00
CRDT- 2017/07/05 06:00
PHST- 2017/07/05 06:00 [pubmed]
PHST- 2018/05/01 06:00 [medline]
PHST- 2017/07/05 06:00 [entrez]
AID - 10.1007/s11695-017-2790-7 [pii]
AID - 10.1007/s11695-017-2790-7 [doi]
PST - ppublish
SO  - Obes Surg. 2017 Dec;27(12):3075-3081. doi: 10.1007/s11695-017-2790-7.