Ng Jun Jie, Leong Wei Qi, Tan Chuen Seng, Poon Keah How, Lomanto Davide, So Jimmy B Y, Shabbir Asim
Department of Surgery, National University Hospital, Level 8, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Obes Surg. 2017 Dec;27(12):3075-3081. doi: 10.1007/s11695-017-2790-7.
Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed procedures for the treatment of obesity. Patients with obesity are more prone to experience opioid-related adverse events (ORAE).
The objective of this study is to determine if a multimodal analgesia protocol (MAP) reduces ORAE and provides effective pain relief for patients after LSG.
This study was conducted at University Hospital, Singapore.
The MAP consists of mandatory pre-operative etoricoxib, intra-operative acetaminophen, and post-operative acetaminophen with optional post-operative tramadol. We identified and collected data for patients who underwent LSG between May 2010 and November 2015 and compared patients before and after the implementation of the MAP.
One hundred fifty-eight patients were included and 68 patients were treated with the MAP. There were no differences in age, gender, body mass index, ethnicity, or comorbidities between the two groups except for the incidence of hypertension (p = 0.015). There was a significant reduction in the incidence of ORAE from 33.3 to 8.8% (p < 0.001) after the implementation of the MAP. There was also a significant reduction in the use of opioids intra-operatively from 58.2 to 43.6 mg (p < 0.001) and post-operatively from 23.7 to 0.7 mg (p < 0.001). Pain scores were similar at 1, 6, and 48 post-operatively, while pain scores were significantly reduced at 12 (p = 0.033) and 24 h (p = 0.02) post-operatively. Multivariate analysis showed that these results remained significant.
Our study suggests that a MAP reduces ORAE and provides effective pain relief for patients undergoing LSG.
腹腔镜袖状胃切除术（LSG）是治疗肥胖症最常用的手术之一。肥胖患者更容易发生阿片类药物相关不良事件（ORAE）。
本研究的目的是确定多模式镇痛方案（MAP）是否能减少LSG术后患者的ORAE并提供有效的疼痛缓解。
本研究在新加坡大学医院进行。
MAP包括术前强制性使用依托考昔、术中使用对乙酰氨基酚以及术后使用对乙酰氨基酚，术后可选择使用曲马多。我们识别并收集了2010年5月至2015年11月期间接受LSG手术的患者的数据，并比较了MAP实施前后的患者情况。
共纳入158例患者，其中68例接受了MAP治疗。除高血压发病率外（p = 0.015），两组患者在年龄、性别、体重指数、种族或合并症方面无差异。MAP实施后，ORAE的发生率从33.3%显著降至8.8%（p < 0.001）。术中阿片类药物的使用量也从58.2毫克显著降至43.6毫克（p < 0.001），术后从23.7毫克降至0.7毫克（p < 0.001）。术后1、6和48小时的疼痛评分相似，而术后12小时（p = 0.033）和24小时（p = 0.02）的疼痛评分显著降低。多变量分析表明这些结果仍然显著。
我们的研究表明，MAP可减少LSG患者的ORAE并提供有效的疼痛缓解。
