Background

A bariatric enhanced recovery after surgery protocol with multimodal analgesia (ERAS/MMA) significantly reduces postoperative pain and opioid needs for many, but not all, patients. In this study, we have attempted to identify preoperative predictors and/or underlying causes of opioid needs in patients having bariatric metabolic surgery (BMS).

Methods

The BMS population included 152 patients; 89 Roux-en-Y gastric bypass (RYGB), 42 sleeve gastrectomy (SG), all under ERAS/MMA protocol. Potential preoperative predictors of opioid use included age, BMI, gender, health status (ASA, obesity-related diseases) and possible underlying causes were surgical outcomes (complications, operative time, length of hospital stay), procedure (RYGB, SG) and approach (laparoscopic, totally robotic). Data was analyzed statistically using student t-test and regression analyses with p<0.05.

Results

Postoperatively, 45% of patients required opioids for pain management; whereas, 55% did not. Opioid needs of patients averaged 10.2 morphine mEq, with 22% of patients requiring >20 mEq (mean=20.4). No significant differences (p>0.05) were found between the opioid-requiring and non-requiring patient groups for BMI, weight, gender, or preoperative health status, but; there was an association between opioid use and younger age. Perioperative complications did not significantly (p>0.05) differ between opioid users and non-users nor did operative times (99.6, 108.1 min, respectively) or LOS (1.22, 1.31 days). Surgical approach (totally robotic, laparoscopic) had no effect on opioid needs but surgical procedure did. Following RYGB, 55% of patients required opioids in contrast to 35% for SG, p=0.02.

Conclusions

Among our BMS patients under ERAS/MMA, only younger age and RYGB were predictors of opioid needs.