Postoperative Pain and Opioid Consumption in the Acute Postoperative Period after Laparoscopic Gastrectomy

Letter to the Editor

To the Editor,

We read with great interest the article of Na et al. in a recent issue of the journal.1 The authors performed a randomized study on 60 patients undergoing laparoscopic gastrectomy and concluded that intraoperative nefopam decreased postoperative pain and opioid consumption in the acute postoperative period after laparoscopic gastrectomy. The authors should be congratulated for performing a well-designed study in an important topic (e.g., acute pain) in patients undergoing gastrointestinal surgery.2,3 The current emphasis on the need to use multimodal analgesics to improve postsurgical pain and reduce opioid intake makes the study very relevant in perioperative medicine.4,5

Although the study of Na et al. was well conducted, there are some questions regarding the study that need to be clarified. First, it is not clear if any local anesthetics were used in the surgical incision as this can substantially alter the study outcomes. Secondly, the authors evaluated multiple primary and secondary outcomes at various postoperative time periods; however, they did not adjust their statistical analysis to prevent Type I errors. Lastly, the improvements in postoperative analgesia were not accompanied by improvements in opioid-related adverse outcomes. It remains to be determined, therefore, if the authors’ findings are clinically important.

We would welcome some comments by the authors as this would help to further support the findings of this important clinical trial.

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Na HS, Oh AY, Ryu JH, Koo BW, Nam SW, Jo J, et al. Intraoperative Nefopam Reduces Acute Postoperative Pain after Laparoscopic Gastrectomy: a Prospective, Randomized Study. J Gastrointest Surg. 2018 Jan 26.  https://doi.org/10.1007/s11605-018-3681-5.
  2. 2.
    Khan JS, Yousuf M, Victor JC, Sharma A, Siddiqui N. An estimation for an appropriate end time for an intraoperative intravenous lidocaine infusion in bowel surgery: a comparative meta-analysis. J Clin Anesth. 2016; 28:95–104.CrossRefPubMedGoogle Scholar
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    El Chaar M, Stoltzfus J, Claros L, Wasylik T. IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center. J Gastrointest Surg. 2016; 20:715–24.CrossRefPubMedGoogle Scholar
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    Li XD, Han C, Yu WL. Is gabapentin effective and safe in open hysterectomy? A PRISMA compliant meta-analysis of randomized controlled trials. J Clin Anesth. 2017; 41:76–83.CrossRefPubMedGoogle Scholar
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    Duttchen KM, Lo A, Walker A, McLuckie D, De Guzman C, Roman-Smith H, et al. Intraoperative ketorolac dose of 15mg versus the standard 30mg on early postoperative pain after spine surgery: A randomized, blinded, non-inferiority trial. J Clin Anesth. 2017; 41:11–15.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Rhode Island HospitalWarren Alpert Medical School of Brown UniversityProvidenceUSA

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