• Obesity
• Diabetes & Endocrinology Clinical Trials
• Nutrition Clinical Trials

• Endocrinology
• Diabetes & Metabolic Syndrome
• Obesity
• Diabetes & Endocrinology Clinical Trials
• Nutrition Clinical Trials

Reducing the use of opioid narcotics in bariatric surgery could lead to less morbidity, shorter hospital stays, more comfortable recovery, and lower costs. In nonbariatric, open surgical procedures, continuous infusion of local anesthetic via catheters reduced narcotic usage, pain scores, time to ambulation, and length of stay (LOS) [Beaussier M et al. Anesthesiology. 2007; Baig MK et al. J Am Coll Surg. 2006]. However, intraoperative infusion of local anesthetics through continuous infusion catheters (CICs) has not been shown to be as effective in bariatric procedures [Iyer CP et al. Surg Ober Relat Dis. 2010; Rosen MJ et al. Surg Endosc. 2009; Sherwinter DA et al. Obes Surg. 2008]. Because there had been no study of laparoscopic sleeve gastrectomy involving local anesthesia delivered via CICs, a prospective double-blind study in patients undergoing sleeve gastrectomy was conducted. The single-institution study results were reported by Elaine M. Cleveland, MD, William Beaumont Army Medical Center, El Paso, Texas, USA.

The goal of this study was to determine if CICs were effective in reducing narcotic usage and would be cost-effective. Patients aged > 18 years were eligible if they had a body mass index (BMI) > 40 kg/m² or a BMI > 35 kg/m² in the presence of comorbidities. Exclusion criteria included revision surgery, single-port surgery, or allergy to local anesthetic. Study end points included total narcotic usage measured in morphine equivalents, antiemetic usage, patient-controlled analgesia (PCA) attempts, pain scores, LOS, and adverse events.

Patients (n = 82) were randomly assigned to ropivacaine (n = 39) or normal saline (placebo; n = 43) by a pharmacist flipping a coin. The pharmacist filled the pain pumps, which were distributed to the operating room. After access to the abdomen was gained, 2 catheters were placed in the preperitoneal space, 1 on each side of abdomen. Each catheter was primed with 5 mL of 1% lidocaine at start of surgery, and an additional 10 mL of lidocaine was administered at the completion of surgery. A pain pump was attached to the catheters in the operating room. The initial flow rate of 7 mL/h was reduced to 4 mL/h on the morning of postoperative day (POD) 1.

On the day of surgery, patients received PCA and intravenous antiemetic medications as needed. On POD 1, patients transitioned to oral fluids, oral narcotics, and oral antiemetics; they were discharged when they could walk and tolerate > 90 mL of oral fluid and when their pain and nausea were controlled by oral medications.

A 1-sided t test was used to compare end points. The demographics of the 2 treatment groups were equivalent. More than 90% of patients were women, with an average age of 35 years and an average BMI of 42.5 kg/m². There were no significant differences between groups in total narcotic usage, PCA attempts, antiemetic usage, or hospital stay.

There were no statistically significant differences in postoperative pain scores between the 2 groups at any time point. Adverse events were minimal, with no hypoxia or ileus in either group.

This study had several limitations, including its being conducted at a single institution among patients who may not represent the national bariatric population. CICs provide no benefit regarding narcotic usage, pain scores, PCA attempts, antiemetic usage, or LOS for patients undergoing laparoscopic sleeve gastrectomy.

• © 2014 MD Conference Express®