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

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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.

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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

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Author information

Authors and Affiliations

  1. Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 North Academy Ave, Danville, PA, 17822, USA

    Ryan D. Horsley, Ellen D. Vogels, Daaron A. P. McField, David M. Parker, James Dove, Marcus Fluck, Jon D. Gabrielsen & Anthony T. Petrick

  2. Enterprise Pharmacy, Geisinger, 100 North Academy Ave, Danville, PA, 17822, USA

    Charles Medico

  3. Center for Pharmacy Innovation and Outcomes, Geisinger, 190 Welles Street, Suite 128, Forty Fort, PA, USA

    Michael R. Gionfriddo

Authors
  1. Ryan D. Horsley
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  2. Ellen D. Vogels
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  3. Daaron A. P. McField
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  4. David M. Parker
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  5. Charles Medico
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  6. James Dove
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  7. Marcus Fluck
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  8. Jon D. Gabrielsen
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  9. Michael R. Gionfriddo
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  10. Anthony T. Petrick
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Corresponding author

Correspondence to Ryan D. Horsley.

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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.

Additional information

This manuscript was presented as a poster at ASMBS Obesity Week 2016

Precis

Among patients undergoing laparoscopic Roux-en-Y gastric bypass, an opioid-sparing multimodal pain protocol utilizing scheduled oral acetaminophen and celecoxib reduces oral morphine equivalent use and length of stay without compromising pain control compared to an opioid-based regimen.

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Horsley, R.D., Vogels, E.D., McField, D.A.P. et al. Multimodal Postoperative Pain Control Is Effective and Reduces Opioid Use After Laparoscopic Roux-en-Y Gastric Bypass. OBES SURG 29, 394–400 (2019). https://doi.org/10.1007/s11695-018-3526-z

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  • DOI: https://doi.org/10.1007/s11695-018-3526-z

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