title: Does epidural morphine loading in addition to thoracic epidural analgesia benefit the postoperative management of morbidly obese patients undergoing open bariatric surgery? A pilot study.
abstract: BACKGROUND
  Insufficient data exist regarding postoperative thoracic epidural analgesia for morbidly obese patients undergoing open bariatric surgery. This study evaluated the effectiveness of morphine loading in a postoperative thoracic epidural analgesic regimen of patient-controlled epidural analgesia (PCEA) with levobupivacaine combined with continuously administered epidural morphine in this patient group.
  
  
  METHODS
  In this prospective randomized controlled trial, 48 superobese patients (body mass index of ≥ 50 kg/m(2)) undergoing open bariatric surgery were randomly allocated to three groups of 16 patients each. Postoperatively, all groups received a continuous epidural morphine infusion of 0.2 mg/h with 0.1 % levobupivacaine via PCEA. Group A did not receive intraoperative epidural morphine loading, while groups B and C received an intraoperative 1- and 2-mg morphine bolus, respectively. Levobupivacaine consumption via PCEA (primary outcome), pain scores at rest and on cough, the time to return of bowel function and ambulation, and arterial blood gas levels (secondary outcomes) were recorded.
  
  
  RESULTS
  The increase in perioperative morphine administration (groups B and C) led to a significantly prolonged return to normal bowel function and delayed ambulation (P<0.05 to 0.01, respectively), without an improvement in postoperative analgesia or a reduction in local anesthetic consumption. Although the prevalence of obstructive sleep apnea (OSA) was high in all groups, no respiratory depression was observed.
  
  
  CONCLUSIONS
  Thoracic PCEA with 0.1 % levobupivacaine combined with continuous epidural morphine administration of 0.2 mg/h without morphine loading is an effective postoperative analgesic regimen that provides adequate pain control, early ambulation, and early return of bowel function in superobese patients, particularly those with OSA.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Patras, Rion, Patras, 26504, Greece, anzotou@hotmail.com.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Zotou
authors.forename: Athina
authors.initials: A
authors.lastname: Siampalioti
authors.forename: Panagiota
authors.initials: P
authors.lastname: Tagari
authors.forename: Leonidas
authors.initials: L
authors.lastname: Paridis
authors.forename: Fotis
authors.initials: F
authors.lastname: Kalfarentzos
authors.forename: Kriton S
authors.initials: KS
authors.lastname: Filos
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D050110:Bariatric Surgery; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D009767:Obesity, Morbid / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010865:Pilot Projects; D011446:Prospective Studies; D013909:Thorax; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine