title: Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection.
abstract: OBJECTIVE
  One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection.
  
  
  METHODS
  With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure.
  
  
  RESULTS
  This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024). Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS). No difference was noted in the postoperative pain scores.
  
  
  CONCLUSIONS
  Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Joselyn
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA ; Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Bhalla
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA ; Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKee
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Pepper
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Diefenbach
authors.affiliation: Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Michalsky
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA ; Department of Anesthesiology and Pain Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA ; Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
keywords: Bariatric surgery; perioperative analgesic requirements; robotic surgery