Interest of Spinal Analgesia in Bariatric Surgery

Abstract

Introduction: Enhanced rehabilitation after surgery (ERAS) should be applied to bariatric surgery. Multimodal analgesia is one of the pillars of ERAS, of which spinal analgesia (SA) is a part. The interest of SA in bariatric surgery is poorly described, yet it can be performed easily even in obese patients, reducing postoperative pain, opioid consumption, and hospitalization time. Materials and Methods: This is a retrospective and comparative study; the objective was to study the feasibility and interest of SA combining 100 μg of morphine and 150 μg of clonidine in bariatric surgery during the first postoperative day. Results: Thirty-six patients were included: 29 patients (81%) benefited from SA (group SA) and 7 benefited from standard analgesia (group S). SA was linked to a decrease in postoperative morphine consumption (odds ratio −2.551, 95% confidence interval [−5.212 to −0.570], p = 0.016). The rate of acute high blood pressure was significantly higher in group S (p = 0.05). There was no difference between the two groups in the occurrence of side effects. Conclusions: SA with morphine and clonidine improves postoperative analgesia. We recommend 0.1 mg as the standard dose. The use of clonidine could make it possible to limit the dose of morphine injected and reduce the postoperative hypertensive risk. french registration: ANSM—RCB ID: 2018-A01310-55.