title: Prospective randomized double-blind controlled trial of continuous local anesthetic infusion to reduce narcotic use in laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  In an era of cost containment and outcome-based medicine, bariatric surgeons are attempting to decrease perioperative morbidity and streamline care. One way of accomplishing this is by decreasing opioid use and hospital stay. Several studies of nonbariatric open procedures have shown that continuous infusion catheters (CIC) are beneficial. Bariatric surgeons frequently utilize CIC, but the data is sparse for the clinical efficacy in laparoscopic procedures.
  
  
  OBJECTIVE
  Evaluate the efficacy of CIC in laparoscopic sleeve gastrectomy.
  
  
  METHODS
  military teaching hospital.
  
  
  METHODS
  In this single institution prospective randomized double-blind controlled study, 82 patients undergoing laparoscopic sleeve gastrectomy (LSG) received either .2% ropivacaine or .9% normal saline (placebo) via CIC. After discharge, total narcotic usage, total antiemetic usage, pain scores, and hospital length of stay were evaluated. A one-way ANOVA was used to assess statistical significance. Power was 80% to detect 52 mg morphine equivalent difference.
  
  
  RESULTS
  A total of 82 patients were enrolled, 39 received ropivacaine, and 43 received placebo. There was no statistically significant difference in narcotic usage between the ropivacaine group and placebo group, 51.9 mg versus 55.2 mg, respectively (P = .63). Ondansetron usage was 10.7 mg and 10.6 mg for ropivacaine and placebo groups. (P = .98). Average pain score was 3.0 for each group (P = .632). Total hospital length of stay was 37.5 hours for ropivacaine group and 38.1 hours for placebo group (P = .768).
  
  
  CONCLUSIONS
  We found no difference in narcotic usage, antiemetic usage, pain scores, or hospital length of stay between ropivacaine and placebo groups. We conclude there is no utility of CIC in LSG.
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.. Electronic address: elaine.m.cleveland@gmail.com.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Cleveland
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Peirce
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Freemyer
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: John P
authors.initials: JP
authors.lastname: Schriver
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Ahnfeldt
authors.affiliation: General Surgery Department, William Beaumont Army Medical Center, El Paso, Texas.
authors.forename: William V
authors.initials: WV
authors.lastname: Rice
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D002408:Catheters, Indwelling; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D017294:Ondansetron / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D018570:Risk Assessment; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017294:Ondansetron; D000077212:Ropivacaine
keywords: Continuous infusion catheters; Laparoscopic sleeve gastrectomy; Narcotic usage