title: Postoperative Opioid Requirements Following Roux-en-Y Gastric Bypass in Patients Receiving Continuous Bupivacaine Through a Pump System: A Retrospective Review.
abstract: BACKGROUND
  Patients who undergo Roux-en-Y gastric bypass (RYGB) surgery have self-reported considerable postoperative pain, often requiring opioid administration.
  
  
  OBJECTIVE
  To determine whether continuous delivery of local anesthetic via an infusion pump system decreased postoperative opioid usage in post-RYGB patients.
  
  
  METHODS
  The electronic health record was used to identify and review 289 patients who underwent RYGB at our institution from January 2009 to October 2011. The treatment group received a continuous infusion of 0.375% bupivacaine administered by intraperitoneal soaker catheter for 48 hours via an infusion pump; the control group did not receive a pump or local anesthetic. Both groups received general anesthesia, nausea prophylaxis, and pain medication. Pain management consisted of opioid-containing patient-controlled analgesia (PCA) for the first 24 hours. Patients transitioned to supplemental intravenous opioid boluses, plus an oral opioid, for the remainder of their stay. Opioid use was measured in terms of morphine equivalents. Secondary outcomes included visual analog scale (VAS) pain scores and length of hospitalization.
  
  
  RESULTS
  Morphine equivalents over the postoperative time period studied were significantly lower in the bupivacaine group than the control group (133 vs 106 mg, respectively; P = .001). There was no significant difference in VAS scores between the 2 groups (P = .80). Finally, the length of hospitalization between the 2 groups did not differ (P = .77).
  
  
  CONCLUSIONS
  We have shown that continuous infusion of bupivacaine, administered via a pain pump system, may have decreased postoperative opioid utilization. There were no differences in VAS scores or length of hospitalization between groups.
authors.affiliation: PGY1 Pharmacy Resident, School of Pharmacy and Health Professions, Creighton University, and Alegent Creighton Health Immanuel Medical Center, Omaha, Nebraska;
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Cohen
authors.affiliation: Assistant Professor of Pharmacy Practice, Creighton University, Omaha, Nebraska;
authors.forename: April N
authors.initials: AN
authors.lastname: Smith
authors.affiliation: Assistant Professor of Pharmacy Sciences, School of Pharmacy and Health Professions, Creighton University, Omaha, Nebraska. Corresponding author: Dr. April Smith, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178; phone: 402-280-3129; fax: 402-280-1268; e-mail: april.smith@creighton.edu .
authors.forename: Brian S
authors.initials: BS
authors.lastname: Henriksen
keywords: bariatric surgery; bupivacaine; gastric bypass; local anesthetic; morbid obesity; pain management; postoperative pain