title: A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery.
abstract: We compared pain intensity, analgesic consumption, patient satisfaction, and length of stay in 114 patients undergoing gastric bypass surgery under general anesthesia. Patients were randomized to incisional local anesthetic infiltration plus postoperative patient-controlled analgesia (Group A), epidural anesthesia and analgesia (Group B), or postoperative patient-controlled analgesia (Group C). All received perioperative nonsteroidal antiinflammatory drugs. Age, sex, body mass index, length of stay, and patient satisfaction were equivalent in all groups. Pain at time 0 and 36 h was the smallest in Group B, greater in Group A, and greatest in Group C. Pain scores in a subset of Group A were lower at all times than in Groups B and C, but this difference was significant only at 0, 12, and 36 h. In responders, infiltration analgesia as part of a multimodal regimen offers a simple, safe, and inexpensive alternative to epidural pain control.
authors.affiliation: Department of Anesthesia, Tufts-New England Medical Center,Tufts University School of Medicine, Boston, Massachusetts 02111, USA. rschumann@lifespan.org
authors.forename: Roman
authors.initials: R
authors.lastname: Schumann
authors.forename: Scott
authors.initials: S
authors.lastname: Shikora
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Weiss
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wurm
authors.forename: Scott
authors.initials: S
authors.lastname: Strassels
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Carr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine