title: Combined preemptive and preventive analgesia in morbidly obese patients undergoing open gastric bypass: A pilot study.
abstract: OBJECTIVE
  It is difficult to balance adequate pain control against the risk of sedation and depressed breathing in severely obese patients. This study assesses the effects of combined preemptive and preventive analgesia on narcotic use after open gastric bypass.
  
  
  METHODS
  Twenty patients were randomized in this prospective double-blind trial comparing preoperative 30 mg intravenous ketorolac (Toradol), 0.25% subcutaneous bupivacaine (Marcaine) with epinephrine along the planned incision, and 0.25% bupivacaine in the rectus fascia before closing with identical injections with 0.9% saline. The patients' self-assessed pain on a visual analogue scale (VAS) and total narcotic use by patient-controlled analgesia (PCA) and rescue medication were recorded.
  
  
  RESULTS
  Age, body mass index (BMI), incision length, and operative times were similar between the two groups, as was the average length of hospital stay (2.9 days). Self-reported pain was less in the treatment group 1 hour postoperatively (P = .01). Narcotic use was less in the treatment group during the first 2 hospital days (51% less on day 1 vs 44.5% less on day 2). Total narcotic use during the hospital stay was reduced by 40% (P = .02).
  
  
  CONCLUSIONS
  Patients receiving combined preemptive and preventive analgesia used significantly less narcotic pain medication than the patients receiving placebo. The effect lasted beyond the duration of action of the local anesthetic.
authors.affiliation: Department of Surgery, University Hospital, University of Medicine and Dentistry of New Jersey/New Jersey Medical School, Newark, New Jersey, USA. kamelgard@LighterForLife.com
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Kamelgard
authors.forename: Kiup Alexander
authors.initials: KA
authors.lastname: Kim
authors.forename: Glen
authors.initials: G
authors.lastname: Atlas
mesh_terms: D000328:Adult; D000698:Analgesia; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine; D020910:Ketorolac