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ANESTHETIC PHARMACOLOGY

A Comparison of Multimodal Perioperative Analgesia to Epidural Pain Management After Gastric Bypass Surgery

Tufts University School of Medicine and Tufts-New England Medical Center, Boston, Massachusetts

Address correspondence and reprint requests to Roman Schumann, MD, Department of Anesthesia, Tufts-New England Medical Center, 750 Washington St., Boston, MA 02111. Address e-mail to rschumann{at}lifespan.org

We compared pain intensity, analgesic consumption, patient satisfaction, and length of stay in 114 patients undergoing gastric bypass surgery under general anesthesia. Patients were randomized to incisional local anesthetic infiltration plus postoperative patient-controlled analgesia (Group A), epidural anesthesia and analgesia (Group B), or postoperative patient-controlled analgesia (Group C). All received perioperative nonsteroidal antiinflammatory drugs. Age, sex, body mass index, length of stay, and patient satisfaction were equivalent in all groups. Pain at time 0 and 36 h was the smallest in Group B, greater in Group A, and greatest in Group C. Pain scores in a subset of Group A were lower at all times than in Groups B and C, but this difference was significant only at 0, 12, and 36 h. In responders, infiltration analgesia as part of a multimodal regimen offers a simple, safe, and inexpensive alternative to epidural pain control.

IMPLICATIONS: We compared pain intensity, analgesic consumption, length of stay, and patient satisfaction in patients undergoing gastric bypass surgery randomized to one of three treatment groups. In responders, infiltration analgesia as part of a multimodal postoperative pain management regimen offered a simple, safe, and inexpensive alternative to epidural pain control.

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