Comparison of Patient Controlled Analgesia to Epidural Analgesia for Postoperative Pain Management after Laparoscopic Gastric Bypass Surgery: A Retrospective Study

Abstract

Background: With the rapidly increasing incidence of obesity conditions, increases in the number of bariatric surgeries required for patients with high body mass index (BMI) provide increasing challenges for the anesthesiologists in the management of both anesthesia and postoperative pain relief. In this study, a comparison was made of the effectiveness of thoracic epidural analgesia (bupivacaine and fentanyl) versus patient controlled analgesia (PCA, morphine and ketorolac) for postoperative pain control. The study hypothesis was that obese patients undergoing gastric bypass surgery receiving local thoracic epidural analgesia will have significantly improved postoperative pain relief, decreased postoperative morbidities and decrease in hospital stay compared to those receiving conventional opioid medications via PCA.Methods: In a university-affiliated hospital, a retrospective chart review of 153 patients aged 20-65 years old with American Society of Anesthesiology (ASA) physical status 2 and 3, scheduled for laparoscopic bypass surgery was conducted. For analysis, patients were divided into 2 groups, those received an epidural solution (0.075% bupivacaine and fentanyl 5 mcg/ml; N=79) or patients received postoperative PCA (morphine and ketorolac 30 mg; N=74). Study outcomes included postoperative pain scores (visual analogue score, VAS) at 6, 12, 24 and 48 hours, incidence of postoperative nausea and vomiting (PONV), pruritus, respiratory complications,  time taken until ambulation and bowel function, length of hospital stay and percentage of patients in hospital greater than 3 days.Results: Patients who received epidurals showed significantly lower pain scores at 6 and 12 hours compared to patients on PCA (P<0.001). Patients who received epidurals had significantly lower incidence of PONV (P=0.002) and a significantly decreased hospital stay (P=0.029) compared to patients on PCA.Conclusions: This study indicated that obese patients who underwent gastric bypass surgery and received thoracic epidurals had significantly improved postoperative pain relief, decreased postoperative side effects and a decrease in hospital stay compared to obese patients who received conventional PCA.  Citation: Rudram Muppuri, George M McKelvey, Hong Wang. Comparison of patient controlled analgesia to epidural analgesia for postoperative pain management after laparoscopic gastric bypass surgery: a retrospective study. J Anesth Perioper Med 2015; 2: 251-5. doi: 10.24015/JAPM.2015.0034This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.