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Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

ABSTRACT: BACKGROUND:Scarce data exists about analgesic requirements in super morbidly obese (SMO) patients who underwent sleeve gastrectomy. We attempted to investigate analgesic requirements for SMO, when compared with morbidly obese (MO) individuals who underwent sleeve gastrectomy and its impact on postoperative outcome. METHODS:We studied 279 consecutive patients (183 MO, 96 SMO) who underwent bariatric surgery. Data analysis included perioperative anaesthetic management, analgesic consumptions, opioids side effects, and ICU admission. RESULTS:The SMO group showed higher patients with asthma, epilepsy, obstructive sleep apnoea (OSA), and ASA III percentages (P?= 0.014, P?= 0.016, P ? 0.001, and P ? 0.001, respectively). There were no significant differences in the total morphine consumption intraoperatively, or after 24 h. However, reduced consumption of intraoperative fentanyl and morphine in SMO when calculated per total body weight (TBW) (P?= 0.004 and P?= 0.001, respectively). At PACU, tramadol consumption per TBW and lean body mass (LBM) were significantly reduced in SMO (P?= 0.001 and P?= 0.025, respectively). Paracetamol consumption was significantly reduced in the SMO group (P?= 0.04). They showed higher comorbidities (P ? 0.001), longer anaesthesia time (P?= 0.033), and greater ICU admissions (P ? 0.001). Vomiting was higher in the MO group (P?= 0.004). Both groups showed comparable pain scores (P?= 0.558) and PACU stay time (P?= 0.060). CONCLUSIONS:Super morbidly obese patients required fewer opioids and analgesics perioperatively. They exhibited higher comorbidities with greater anaesthesia time and ICU admissions. PACU stay time and pain scores were comparable.

SUBMITTER: Elgendy H

PROVIDER: S-EPMC7260144 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

Elgendy Hamed H Youssef Talha T Banjar Ahmad A Elmorsy Soha S

Obesity surgery 20200701 7

<h4>Background</h4>Scarce data exists about analgesic requirements in super morbidly obese (SMO) patients who underwent sleeve gastrectomy. We attempted to investigate analgesic requirements for SMO, when compared with morbidly obese (MO) individuals who underwent sleeve gastrectomy and its impact on postoperative outcome.<h4>Methods</h4>We studied 279 consecutive patients (183 MO, 96 SMO) who underwent bariatric surgery. Data analysis included perioperative anaesthetic management, analgesic con ...[more]

PMID: 32246413

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Project description:BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG. PATIENTS AND METHODS:Morbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed. RESULTS:Eighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: -4 [-8.3/0.2] mmHg, p=0.060; -1.4 [-3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman's r=-0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056). CONCLUSION:Patients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9-92.6 mmHg.

Dataset Information

Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

Publications

Decreased Analgesic Requirements in Super Morbidly Versus Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy.

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