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De Cassai A, Paganini G, Pettenuzzo T, Zarantonello F, Boscolo A, Tulgar S, Carron M, Munari M, Navalesi P. Single-Shot Regional Anesthesia for Bariatric Surgery: a Systematic Review and Network Meta-Analysis. Obes Surg 2023; 33:2687-2694. [PMID: 37498489 DOI: 10.1007/s11695-023-06737-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Laparoscopic bariatric surgeries can cause intense postoperative pain. Opioid medication can alleviate the pain but can have harmful side effects especially in patients with obstructive sleep apnea. To promote early recovery, enhanced recovery after surgery guideline advises minimizing opioid use and opting for alternative analgesics. This paper aims to investigate the effect of regional anesthesia techniques through a systematic review and network meta-analysis. Primary outcome is postoperative morphine equivalent consumption at 24 h. METHODS Search was conducted in the following databases: PubMed, CENTRAL, Scopus, and EMBASE, from the inception until 10 January 2023. The eligibility criteria were determined by PICOS, including postoperative opioid consumption, pain scores, time to ambulate, use of additional analgesics, and adverse events. The quality assessment was performed using the Risk of Bias 2 Tool, and the certainty of evidence was assessed using the GRADE approach. Funnel plots were used to evaluate publication bias. RESULTS We included 22 studies in quantitative synthesis. A review of 12 studies found that all techniques had a lower mean consumption of opioids compared to placebo or no intervention, with TAP block having the greatest reduction. The quality of evidence for postoperative pain, PONV, time to deambulate, and use of rescue analgesics, was rated as moderate, with TAP block being the most effective intervention. There was no publication bias in any outcome. CONCLUSIONS TAP block is superior to other regional anesthesia techniques in reducing opioid consumption, pain, PONV, and use of rescue analgesics in bariatric surgery. However, further research is needed.
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Affiliation(s)
- Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy.
| | - Greta Paganini
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | | | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Samsun Training and Research Hospital, Samsun University, Samsun, Turkey
| | - Michele Carron
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit Sant'Antonio, University Hospital of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy
- UOC Anesthesia and Intensive Care Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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Dai S, Fu R, Jiang S, He Y, Huang T, Zhou B, Gong H. Effect of Intraperitoneal Local Anesthetics in Laparoscopic Bariatric Surgery: A Meta-Analysis of Randomized Controlled Trials. World J Surg 2022; 46:2733-2743. [PMID: 35933496 DOI: 10.1007/s00268-022-06685-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The effectiveness of intraperitoneal local anesthesia (IPLA) has been confirmed in other fields, but its use in bariatric surgery remains debatable. This study aimed to evaluate the analgesic effect of IPLA in bariatric surgery. METHODS PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2022. All randomized controlled trials (RCTs) assessing IPLA's analgesic effect in bariatric surgery were included in this study. Pain-related indicators were the outcome. RESULTS Ten RCTs with 979 patients were included. Postoperative pain scores were significantly lower in IPLA group. Subgroup analysis demonstrated that IPLA was associated with lower pain scores in 6 h and at 24 h compared to the control group, without significant differences at 8, 12, and 48 h. Meanwhile, IPLA reduced the dose of opioids taken postoperatively. Additionally, there were no differences in adverse events between the two groups. As far as the number of postoperative analgesics used and hospital stays were concerned, our results did not show statistical differences between the two groups. CONCLUSION IPLA can reduce postoperative pain safely and effectively, particularly during the early postoperative stage.
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Affiliation(s)
- Senjie Dai
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Fu
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Siya Jiang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuanfang He
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tongmin Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bin Zhou
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Hongjun Gong
- Department of Anesthesiology, Ningbo Yinzhou No. 2 Hospital, 998 North Qianhe Road, Yinzhou District, Ningbo, 315100, Zhejiang, China.
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Kaur R, Seal A, Lemech I, Fisher OM, Williams N. Intraperitoneal Instillation of Local Anesthetic (IPILA) in Bariatric Surgery and the Effect on Post-operative Pain Scores: a Randomized Control Trial. Obes Surg 2022; 32:2349-2356. [PMID: 35508748 PMCID: PMC9276555 DOI: 10.1007/s11695-022-06086-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Effective analgesia after bariatric procedures is vital as it can reduce post-operative opioid use. This leads to less nausea which may be associated with shorter post-operative length of stay (LOS). Understanding analgesic requirements in patients with obesity is important due to the varied physiology and increased number of comorbidities. OBJECTIVES The aim of this study was to evaluate the efficacy of intraperitoneal instillation of local anesthetic (IPILA) to reduce opioid requirements in patients undergoing laparoscopic bariatric surgery. METHODS A double-blinded randomized control trial was conducted to compare intraperitoneal instillation of ropivacaine to normal saline in 104 patients undergoing bariatric surgery. The primary endpoint was pain in recovery with secondary endpoints at 1, 2, 4, 6, 24, and 48 h post-operatively. Further endpoints were post-operative analgesic use and LOS. Safety endpoints included unexpected reoperation or readmission, complications, and mortality. RESULTS There were 54 patients in the placebo arm and 50 in the IPILA. Pain scores were significantly lower in the IPILA group both at rest (p = 0.04) and on movement (p = 0.02) in recovery with no difference seen at subsequent time points. Equally, IPILA was independently associated with reducing severe post-operative pain at rest and movement (adjusted odds ratio [aOR] 0.28, 95% CI 0.11-0.69, p = 0.007 and aOR 0.25, 95% CI 0.09-0.62, p = 0.004, respectively). There was no significant difference in LOS, opioid use, antiemetic use, morbidity, or mortality between the intervention and placebo groups. CONCLUSION The administration of ropivacaine intraperitoneally during laparoscopic bariatric surgery reduces post-operative pain in the recovery room but does not reduce opioid use nor LOS.
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Affiliation(s)
- Ramandeep Kaur
- School of Medicine Sydney, Rural Clinical School (Wagga Wagga), The University of Notre Dame Australia, 40 Hardy Avenue, PO Box 5050, Wagga Wagga, NSW, 2650, Australia.
| | - Alexa Seal
- School of Medicine Sydney, Rural Clinical School (Wagga Wagga), The University of Notre Dame Australia, 40 Hardy Avenue, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
| | - Igor Lemech
- Anesthetic Department, Calvary Hospital Riverina, 26-36 Hardy Avenue, Wagga Wagga, NSW, 2650, Australia
| | - Oliver M Fisher
- Upper Gastrointestinal Surgery, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
| | - Nicholas Williams
- School of Medicine Sydney, Rural Clinical School (Wagga Wagga), The University of Notre Dame Australia, 40 Hardy Avenue, PO Box 5050, Wagga Wagga, NSW, 2650, Australia
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Efficacy of intraperitoneal bupivacaine in laparoscopic bariatric surgery. Ann Med Surg (Lond) 2022; 73:103229. [PMID: 35079367 PMCID: PMC8767298 DOI: 10.1016/j.amsu.2021.103229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In [patients undergoing bariatric surgery], is [intraperitoneal local bupivacaine during the operation ] associated with [ lower pain score and decrease in post operative pain medications]? The search has been done and six randomized trial studies are considered to be appropriate to answer this question. The outcome assessed is the value of intraperitoneal bupivacaine in bariatric surgery in terms of effect on the pain score and post operative analgesia. We concluded that intraperitoneal bupivacaine causes improvement in both the pain score and post operative analgesia. Use of intraperitoneal bupivacaine, during bariatric procedures, improves post operative pain score. There is decrease in the post operative analgesia when intraperitoneal bupivacaine is used in the bariatric operations. Different ways can be used to apply intraperitoneal bupivacaine in the bariatric surgery field.
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Transversus Abdominis Plane Block Versus Intraperitoneal Local Anesthetics in Bariatric Surgery: A Systematic Review and Network Meta-analysis. Obes Surg 2021; 31:4305-4315. [PMID: 34282569 DOI: 10.1007/s11695-021-05564-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transversus abdominis plane (TAP) block and intraperitoneal local anesthetics (IPLA) are widely investigated techniques that potentially improve analgesia after bariatric surgery. The analgesic efficacy of TAP block has been shown in previous studies, but the performance of TAP block can be difficult in patients with obesity. We performed a systematic review and meta-analysis to compare the analgesic efficacy of TAP block and IPLA. An alternative technique is useful in clinical setting when TAP block is not feasible. METHODS We searched PubMed, Embase, and CENTRAL from inception until August 2020 for randomized controlled trials comparing both techniques. The primary outcome was cumulative morphine consumption at 24 h. Secondary pain-related outcomes included pain score at rest and on movement at 2, 6, 12, and 24 h; postoperative nausea and vomiting; and length of hospital stay. RESULTS We included 23 studies with a total of 2,178 patients. TAP block is superior to control in reducing opioid consumption at 24 h, improving pain scores at all the time points and postoperative nausea and vomiting. The cumulative opioid consumption at 24 h for IPLA is less than control, while the indirect comparison between IPLA with PSI and control showed a significant reduction in pain scores at rest, at 2 h, and on movement at 12 h, and 24 h postoperatively. CONCLUSIONS Transversus abdominis plane block is effective for reducing pain intensity and has superior opioid-sparing effect compared to control. Current evidence is insufficient to show an equivalent analgesic benefit of IPLA to TAP block.
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Nagliati C, Contin R, Pennisi D. Considering ERAS protocols as a part of multimodal analgesia in bariatric surgery. Surg Obes Relat Dis 2020; 16:2132-2133. [PMID: 32611492 DOI: 10.1016/j.soard.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Carlo Nagliati
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Roberta Contin
- Department of Anesthesia, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Damiano Pennisi
- Department of Surgery, San Giovanni di Dio Hospital, Gorizia, Italy
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Hsu WH, Chang HM, Lee YL, Prasannan A, Hu CC, Wang JS, Lai JY, Yang JM, Jebaranjitham N, Tsai HC. Biodegradable polymer-nanoclay composites as intestinal sleeve implants installed in digestive tract for obesity and type 2 diabetes treatment. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 110:110676. [PMID: 32204104 DOI: 10.1016/j.msec.2020.110676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
Obesity and type 2 diabetes have become serious health problems in 21st century. Development of non-invasive treatment to treat obesity and type-2 diabetes is still unmet needs. For targeting on this, one of the promising treatments is to implant an intestine sleeve in the gastrointestinal tract for limitation of food absorption. In this context, biodegradable polymer intestine sleeve was composed of polycaprolactone (PCL), poly-DL-lactic acid (PDLLA) and disk-shape nano-clay (Laponite®), and fabricated as an implantable device. Here, Laponite® as a rheological additive to improve the compatibility of PCL and PDLLA, and the polymers/clay composites were also evaluated by scanning electron microscopy SEM analysis and mechanical measurements. The mass ratio 90/10/1 of PCL/PDLLA/Laponite® composite was selected for fabrication of intestine sleeve, because of the highest toughness and flexibility, which are tensile strength of 91.9 N/mm2 and tensile strain of 448% at the failure point. The prepared intestine sleeve was implanted and deployed at the duodenum in type2 diabetic rats, providing significant benefits in control of the body weight and blood glucose, while compared with the non-implanted type 2 diabetic rats. More importantly, the food intake records and histopathological section reports presented that the implanted rats still have normal appetites and no noticeable acute symptoms of inflammation in the end of the test. These appreciable performances suggested the implantation of biocompatible polymer composites has a highly potential treatment for obesity and type 2 diabetes.
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Affiliation(s)
- Wei-Hsin Hsu
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC; Taiwan Instrument Research Institute, National Applied Research Laboratories, Taiwan, ROC
| | - Hao-Ming Chang
- Division of General Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Ya-Lun Lee
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC
| | - Adhimoorthy Prasannan
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC; Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taiwan, ROC
| | - Chien-Chieh Hu
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC; Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taiwan, ROC; R&D Center for Membrane Technology, Chung Yuan Christian University, Taiwan, ROC
| | - Jun-Sheng Wang
- Taiwan Instrument Research Institute, National Applied Research Laboratories, Taiwan, ROC
| | - Juin-Yih Lai
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC; Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taiwan, ROC; R&D Center for Membrane Technology, Chung Yuan Christian University, Taiwan, ROC
| | - Jen Ming Yang
- Department of Chemical and Materials Engineering, Chang Gung University, Taiwan, ROC; Department of General Dentistry, Chang Gung Memorial Hospital, Taiwan, ROC
| | - Nimita Jebaranjitham
- PG Department of Chemistry, Women's Christian College, (An Autonomous Institution Affiliated to University of Madras), Chennai, India
| | - Hsieh-Chih Tsai
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taiwan, ROC; Advanced Membrane Materials Center, National Taiwan University of Science and Technology, Taiwan, ROC.
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Effect of intraperitoneal bupivacaine on postoperative pain in laparoscopic bariatric surgeries. Surg Obes Relat Dis 2019; 16:299-305. [PMID: 31836291 DOI: 10.1016/j.soard.2019.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/06/2019] [Accepted: 10/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postoperative pain has many adverse effects and, if not properly controlled, it may lead to a wide range of complications. Opioids, as frequently used drugs for pain control, have some serious respiratory and gastrointestinal complications, especially in obese patients. OBJECTIVES In this study, we planned to evaluate the effect of intraperitoneal bupivacaine lavage on postoperative pain in laparoscopic bariatric surgeries. SETTING The study was conducted in Firoozgar Hospital (affiliated to Iran University of Medical Sciences), Tehran, Iran. METHODS In this clinical trial, 106 patients scheduled for laparoscopic bariatric surgery, randomly assigned to receive either intraperitoneal lavage with 50 mL of .2% bupivacaine or the same volume of normal saline during the operation. One-gram intravenous paracetamol was infused for all patients at the end of surgery, and all patients received intravenous paracetamol infusion for 1 day after surgery. Pain level, assessed by visual analog scale, was recorded at 1, 4, 8, and 24 hours after surgery. Total additive analgesics administered during the first day after surgery was also recorded. RESULTS The pain score during the first 24 hours after surgery decreased significantly in both groups, but comparing the groups showed that pain level at 1, 4, 8, and 24 hours after surgery in the bupivacaine group was significantly lower than the normal saline group (P < .05). Also, opioid consumption during 24 hours was significantly lower in the bupivacaine group (P < .001). CONCLUSIONS Intraperitoneal lavage with bupivacaine is an effective approach to control postoperative pain in obese patients undergoing laparoscopic bariatric surgery.
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