Background

Local anesthesia decreases postoperative opioid use (POU) in bariatric surgery. Despite this, the best-reported outcome on POU in oral morphine equivalents (OME) is 23.8. We aim to compare the addition of Bupivacaine/Meloxicam (ZynrelefTM, Heron Therapeutics, (Z)) to Bupivacaine alone on POU after laparoscopic sleeve gastrectomy (LSG).

Methods

With informed consent, 212 patients scheduled for LSG were randomly divided into Z group (n=106) and Non-Z group (n=106). Both groups had same intraoperative anesthesia. Non-Z group received 100ml of 0.25%Bupivacaine HCl+10mg Dexamethasone on all port sites. Z-group received additional 7ml of Bupivacaine/Meloxicam (29.25mg/0.88mg/ml) only in main incision site. Demographics, analgesic use, hiatal hernia repair (HHR), and operative time (OT)(mins) were recorded. Outcomes included postoperative pain scores (PPS) hourly in PACU, 4-hourly on surgical floor (SF), in-hospital opioid use (IHOU), and post-discharge opioid prescriptions (PDOP).

Results

Mean age (years) and BMI were similar in Z and non-Z groups respectively (42.6±9.5 vs 40.7±10.2), and (45.3±6.1 vs, 44.5±6.7kg/m2). Z compared to non-Z group had a lower % chronic pain (23.6% vs. 44.3%, p=0.002) and HHR (12.2% vs. 24.5%, p=0.03) and a higher mean OT (124±25 vs.109±21, p<0.0001). Z group had a lower mean PACU OME(1.6±6.3 and 3.0±6.5, p=0.04), total OME(2.0±6.5 vs. 3.5±6.8, p=0.04). All Z-group PPS were lower, and 3-hr PACU scores were statistically significant. Z use had significant independent effect on total OME on regression analysis, unlike HHR, OT, and CP.

Conclusions

Adding ZynrelefTM decreases the PPS and POU in LSG. A remarkably lower mean total OME was noted compared to previous studies.