Multimodal Postoperative Pain Control Is Effective and Reduces Opioid Use After Laparoscopic Roux-en-Y Gastric Bypass
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.
KeywordsMultimodal pain control Bariatric surgery Opioid Acetaminophen Celecoxib
Hospital consumer assessment of healthcare providers and systems
Length of stay
Laparoscopic Roux-en-Y gastric bypass
Total oral morphine equivalent units
Non-steroidal anti-inflammatory drugs
Prior to opioid-sparing multimodal pain protocol
Opioid-sparing multimodal pain protocol
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.
- 6.Ghaferi AA, Mohanty S, Lee JS, Stricklen A, Ross R, Carlin AM. Bariatric Surgical Patients at Risk for Newly Persistent Opioid Use. Am Coll Surg; 2017.Google Scholar
- 10.Berger ER, Huffman KM, Fraker T, et al. Prevalence and risk factors for bariatric surgery readmissions: findings from 130,007 Admissions in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Ann Surg. 2016;15.Google Scholar
- 18.Baldini A, Von Korff M, Lin EHB. A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. The Primary Care Companion to CNS Disorders. 2012;14(3). https://doi.org/10.4088/pcc.11m01326.
- 19.Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, executive committee, and administrative council. J Pain. 2016;17(2):131–57.CrossRefGoogle Scholar
- 21.McAuley D. Opioid Analgesic Converter. Available at: http://www.globalrph.com/narcoticonv.htm.
- 23.Anson P. AMA Drops Pain as Vital Sign. Available at: https://www.painnewsnetwork.org/stories/2016/6/16/ama-drops-pain-as-vital-sign. Accessed 13 June 2018.
- 24.Paulozzi L, Baldwin G, Franklin G, et al. CDC grand rounds: prescription drug overdoses - a U.S. epidemic. MMWR Morb Mortal Wkly Rep. 2012;61(1):10–3.Google Scholar
- 27.Gandhi K, Viscusi E. Multimodal pain management techniques in hip and knee arthroplasty. J NY Sch Reg Anesth. 2009;13. Retrieved from https://www.nysora.com/files/2013/pdf/(v13p1-10)MultimodalPainManagement.pdf. Accessed 15 June 2017.
- 28.Ziemann-Gimmel P, Hensel P, Koppman J, et al. Multimodal analgesia reduces narcotic requirements and antiemetic rescue medication in laparoscopic Roux-en-Y gastric bypass surgery. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery. 2013;9(6):975–80.CrossRefGoogle Scholar
- 30.Wang S, Saha R, Shah N, et al. Effect of intravenous acetaminophen on postoperative opioid use in bariatric surgery patients. Pharm Ther. 2015;40(12):847–50.Google Scholar