Perioperative truncal peripheral nerve blocks for bariatric surgery: an opioid reduction strategy |
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| Institution: | 1. Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;2. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;3. North Allegheny Senior High School, Pittsburgh, Pennsylvania;1. Center for Clinical and Translational Science and Training, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;2. Division of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio;4. Department of Surgery, Lurie Children''s Hospital of Chicago, Chicago, Illinois;5. Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;1. Plataforma INVEST Medicina UANL KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México;2. Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. José E. González,\" Universidad Autónoma de Nuevo León, Monterrey, México |
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| Abstract: | BackgroundBariatric surgical patients are vulnerable to cardiopulmonary depressant effects of opioids. The enhanced recovery after surgery (ERAS) protocol to improve postoperative morbidity recommends regional anesthesia for postoperative pain management. However, there is limited evidence that peripheral nerve blocks (PNB) have added benefit.ObjectiveStudy the effect of PNB on postoperative pain and opioid use following bariatric surgery.SettingAcademic medical center, United States.MethodsWe conducted a cohort study of patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. A total of 44 patients received the control ERAS protocol with preoperative oral extended-release morphine sulfate (MS), while 45 patients underwent a PNB with either intrathecal morphine (IM) or oral MS per local ERAS protocol. The PNB group either underwent preoperative bilateral T7 paravertebral (PVT) PNBs (27 patients) with IM or postoperative transversus abdominis plane (TAP) PNBs (18 patients) with oral MS. The primary outcome compared total opioid consumption between the ERAS control group and the PNB group up to 48 hours postoperatively. Secondary outcomes included comparison by block type and postoperative pain scores.ResultsPVT or TAP PNB patients had a reduction in mean postoperative oral morphine equivalent (OME) requirements compared with the ERAS protocol cohort at 24 hours (93.9 versus 42.8 mg), P < .0001; at 48 hours (72.6 versus 40.5 mg); and in pain scores at 24 hours (5.64/10 versus 4.46/10), P = .02. OME and pain scores were higher in the SG cohort.ConclusionAddition of truncal PNB to standard ERAS protocol for bariatric surgical patients reduces postoperative total opioid consumption. |
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| Keywords: | Peripheral nerve block Paravertebral block Transversus abdominis plane block Bariatric surgery Gastric bypass Sleeve gastrectomy Opioid Regional Anesthesia Enhanced recovery after surgery |
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