Bariatric surgery is an effective and safe approach to maintaining permanent weight loss and decreasing obesity related co-morbidities. Beneficial effects of peri-operative use of thoracic epidural analgesia on pulmonary, cardiovascular, and gastrointestinal functions, health-related quality of life, morbidity and mortality after abdominal surgery have been shown. Moreover, thoracic epidural analgesia is considered the gold standard for postoperative pain management after major gastrointestinal surgery. Due to technical difficulties, regional anaesthesia techniques are limited in obese individuals. In addition, different studies have shown comparable pain control of PCEA and IV-PCA in obese patients undergoing bariatric surgery.^ We retrospectively compared the postoperative periods of individuals who underwent elective laparoscopic gastric bypass surgery in order to evaluate the influence of pain management strategies on postoperative NRS-scores and postoperative course.
Participants were retrospectively assigned to an IV-PCA-group or a PCEA-group according to their postoperative pain management. Data of 142 patients were assessed and included in this study.^ Data collected from each patient included demographics (age, gender, body height, current weight, excess weight, ideal weight, body-mass-index), classification of obesity, pre-operative co-morbidities (ASA-classification), details of surgical procedure (type of surgical technique, duration of surgery), post-operative course (post-operative pain management, drugs, post-operative ward, surgical complications, complications due to pain therapy, duration of PCA), post-operative NRS-scores (first, second, third, and fourth post-operative day), and medical follow-ups (percentage of excess weight loss, post-operative BMI).
Data of 142 patients were analysed with 63 patients (44.4%) in the PCEA-group and 79 patients (55.6%) in the IV-PCA-group.^ We observed no differences across the groups with respect to sex, age, ASA-score, comorbidities, post-operative BMI, body height, pre- and post-operative weight, ideal weight, weight loss, %EWL, duration of surgery, and post-operative ward, except that BMI (p = 0.025) and excess weight before surgery (p = 0.029) were significantly higher in the IV-PCA-group. Neither did we observe differences in pain NRS-scores at rest between the two groups throughout the study period. However, individuals in the IV-PCAgroup received significantly more concomitant medication, and duration of PCA was longer in the PCEAgroup (p < 0.01).^ Finally, there was no difference in pruritus due to pain therapy between the two groups, but patients with IV-PCA had an increased risk for surgical complications (p = 0.045) compared to patients with PCEA.
We conclude, that PCEA and opioid-based IV-PCA are both safe and effective methods for pain relief after elective laparoscopic gastric bypass surgery. However, this present study provides evidence that, particularly for obese patients, PCEA is more beneficial than IV-PCA, which is borneout by a significantly lower incidence of surgical complications observed in patients receiving PCEA.