title: Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia).
abstract: Although bariatric surgery is actually mainly performed laparoscopically, analgesic optimization continues being essential to reduce complications and to improve the patients' comfort. The aim of this study is to evaluate the postoperative pain after analgesia iv exclusively, or associated with epidural analgesia or port-sites infiltration with bupivacaine.
  
  
  
  A prospective randomized study of patients undergoing laparoscopic sleeve gastrectomy between 2012 and 2014 was performed. Patients were divided into three groups: Analgesia iv exclusively (Group 1), epidural analgesia + analgesia iv (Group 2) and port-sites infiltration + analgesia iv (Group 3). Pain was quantified by means of a Visual Analogic Scale, and morphine rescue needs were determined 24 h after surgery.
  
  
  
  A total of 147 were included. Groups were comparable in age, gender and BMI. There were no differences in operation time, complications, mortality or hospital stay between groups. Median pain 24 h after surgery was 5 in Group 1, 2.5 in Group 2 and 2 in Group 3 (P = 0.01), without statistically significant differences between Groups 2 and 3. In Group 1, morphine rescue was necessary in 16.3 % of the cases, 2 % in Group 2 and 2 % in Group 3 (P = 0.014), without statistically significant differences between Groups 2 and 3.
  
  
  
  Epidural analgesia and port-sites infiltration with bupivacaine, associated with analgesia iv, reduce the postoperative pain, when compared with analgesia iv exclusively.
  
  
  
  ClinicalTrials.gov Identifier: NCT02662660.
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain. jruiztovar@gmail.com.
authors.forename: Jaime
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.affiliation: Department of Anaesthesiology, Bariatric Surgery Unit, University Hospital Elche, Alicante, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Muñoz
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Gonzalez
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Elche, Alicante, Spain.
authors.forename: Lorea
authors.initials: L
authors.lastname: Zubiaga
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: García
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain.
authors.forename: Montiel
authors.initials: M
authors.lastname: Jimenez
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrigni
authors.affiliation: Department of Surgery, Bariatric Surgery Unit, University Hospital Rey Juan Carlos, Corazon de Maria, 64, 7 J, 28002, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Durán
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D015360:Analgesia, Epidural; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D050110:Bariatric Surgery; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004177:Dipyrone / Q000627:therapeutic use; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D010535:Laparoscopy; D000077554:Levobupivacaine; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D064232:Visual Analog Scale
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D000082:Acetaminophen; D004177:Dipyrone; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: Epidural analgesia; Laparoscopy; Pain; Port-sites infiltration; Sleeve gastrectomy