title: Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery.
abstract: Postoperative pain and analgesia present challenges in bariatric surgery patients. Multimodal analgesia may provide better efficacy, less complications and expedite fast-track bariatric surgical care. There are no studies of the broader topic of perioperative analgesia and the overall impact. This study highlights the impact of multimodal intraoperative analgesia on fast-track bariatric surgery.
  
  
  
  This observational study examined the perioperative outcome data of 412 consecutive laparoscopic bariatric surgery patients over a 6-year period. Perioperative outcome and variables were analysed and compared between different intraoperative analgesia types.
  
  
  
  Mean BMI was 49, mean age was 42 and male:female ratio was 1:4. About 82% of patients received multimodal intraoperative analgesia, comprising various combinations of bupivacaine infiltration and intravenous acetaminophen, morphine, tramadol, parecoxib or diclofenac. Morphine was administered in 83% of patients and tramadol in 17%. Multimodal intraoperative analgesia provided better postoperative analgesia, shorter postanaesthesia care unit (PACU) duration, lower postoperative opioid requirement, less postoperative vomiting, earlier postoperative oral intake, earlier ambulation and shorter hospital stay compared to unimodal intraoperative morphine analgesia (p = 0.0001). Multimodal analgesia comprising tramadol + acetaminophen + diclofenac provided better postoperative analgesia, shorter PACU duration, lower postoperative opioid requirement, earlier ambulation, shorter hospital stay and less postoperative hypopnoea compared to patients who received morphine (p = 0.0001).
  
  
  
  Multimodal intraoperative analgesia provides better postoperative analgesia, less complications and better perioperative outcomes and facilitates fast-track bariatric surgical care. Tramadol is suitable, efficacious and safe and associated with the best perioperative outcomes in bariatric surgery patients.
authors.affiliation: Department of Anaesthesia, University of British Columbia, Vancouver, BC, Canada. olu.bamgbade@gmail.com.
authors.forename: Olumuyiwa A
authors.initials: OA
authors.lastname: Bamgbade
authors.affiliation: Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Oluwafemi
authors.initials: O
authors.lastname: Oluwole
authors.affiliation: Department of Surgery, University of Manchester, Manchester, UK.
authors.forename: Rong R
authors.initials: RR
authors.lastname: Khaw
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D019990:Perioperative Care; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D014147:Tramadol
keywords: Enhanced recovery; Fast track; Laparoscopic bariatric surgery; Multimodal analgesia; Perioperative analgesia; Tramadol