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Multimodal Postoperative Pain Control Is Effective and Reduces Opioid Use After Laparoscopic Roux-en-Y Gastric Bypass

  • Ryan D. Horsley
  • Ellen D. Vogels
  • Daaron A. P. McField
  • David M. Parker
  • Charles Medico
  • James Dove
  • Marcus Fluck
  • Jon D. Gabrielsen
  • Michael R. Gionfriddo
  • Anthony T. Petrick
Original Contributions

Abstract

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.

Keywords

Multimodal pain control Bariatric surgery Opioid Acetaminophen Celecoxib 

Abbreviations

CI

Confidence interval

HCAHPS

Hospital consumer assessment of healthcare providers and systems

LOS

Length of stay

LRYGB

Laparoscopic Roux-en-Y gastric bypass

TME

Total oral morphine equivalent units

NSAIDS

Non-steroidal anti-inflammatory drugs

PCA

Patient-controlled analgesia

POD

Postoperative day

SD

Standard deviation

Pre-MMPP

Prior to opioid-sparing multimodal pain protocol

MMPP

Opioid-sparing multimodal pain protocol

Notes

Compliance with Ethical Standards

Conflict of Interest

Horsley, Vogels, McField, Parker, Dove, Fluck, Gabrielsen, Gionfriddo, and Petrick have no conflicts of interest. Medico has a relevant financial activity outside of the submitted work.

Ethical Approval Statement

For this type of study formal consent is not required.

Informed Consent Statement

Does not apply.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ryan D. Horsley
    • 1
  • Ellen D. Vogels
    • 1
  • Daaron A. P. McField
    • 1
  • David M. Parker
    • 1
  • Charles Medico
    • 2
  • James Dove
    • 1
  • Marcus Fluck
    • 1
  • Jon D. Gabrielsen
    • 1
  • Michael R. Gionfriddo
    • 3
  • Anthony T. Petrick
    • 1
  1. 1.Division of Bariatric and Foregut SurgeryGeisinger Medical CenterDanvilleUSA
  2. 2.Enterprise PharmacyGeisingerDanvilleUSA
  3. 3.Center for Pharmacy Innovation and OutcomesGeisingerForty FortUSA

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