title: Preoperative Slow-Release Morphine Reduces Need of Postoperative Analgesics and Shortens Hospital Stay in Laparoscopic Gastric Bypass.
abstract: BACKGROUND
  As most bariatric procedures are performed by laparoscopy, hospital stay is exceptionally short, despite the habitus of patients and the rather extensive intra-abdominal surgery. To facilitate postoperative mobilization, most patients are given repeated single doses of morphine, a drug with several side effects. We aimed to evaluate the effect of preoperative treatment with a tablet of slow-release morphine (SRM) on postoperative analgesic consumption and length of stay (LOS) in laparoscopic gastric bypass (LGBP).
  
  
  METHODS
  The SRM group (244 patients) was retrospectively compared to a control group (197 patients) concerning postoperative pain management and hospital stay by studying medical charts and data from Scandinavian Obesity Surgery Registry (SOReg).
  
  
  RESULTS
  Patients in the SRM group needed significantly less analgesics during days 0, 1, and 2 postoperatively, morphine 10.7 vs. 13.6 mg, 10.2 vs. 13.9 mg, and 1.1 vs. 3.6 mg, respectively, p < 0.05, as well as acetaminophen, p < 0.05. According to a subgroup analysis, 20 mg of SRM was needed to obtain these effects. In addition, SRM patients had shorter hospital stay (2.3 vs. 3.5 days, p < 0.05) than the control group. No negative side effects were seen.
  
  
  CONCLUSIONS
  Preoperatively administered slow-release morphine significantly reduced the need for postoperative analgesics and shortened hospital stay, without side effects or other complications. At our department, the studied regime is now routinely used in all bariatric surgery and we have started to use the concept in other groups of surgical patients.
authors.affiliation: Department of Surgical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Hedberg
authors.affiliation: Department of Surgical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden.
authors.forename: Hanna
authors.initials: H
authors.lastname: Zacharias
authors.affiliation: Department of Anesthesiology, Uppsala University, SE 751 85, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Janson
authors.affiliation: Department of Surgical Sciences, Uppsala University, SE 751 85, Uppsala, Sweden. magnus.sundbom@surgsci.uu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009767:Obesity, Morbid / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy*; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D009020:Morphine
keywords: Analgesics; Laparoscopic gastric bypass; Morphine; Postoperative care; Prolonged-release morphine