Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients

Abstract

Background: Obesity and intraoperative (IO) opioid are risk-factors during bariatric surgery and require certain manipulations to deal with. Enhanced recovery after surgery (ERAS) and spare-opioid use protocol (SOUP) might aid to bypass these risk factors Objectives: Evaluation of the outcomes of ERAS protocol with SOUP application for morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). Patients and methods: 60 obese patients were allocated into Group-C received conventional opioid-based anaesthesia and postoperative (PO) analgesia and Group-E received the ERAS protocol with SOUP application. All patients received balanced sevoflurane anesthesia 2% in oxygen 100% and rocuronium and 4-ports LSG. The study outcome is the efficacy of the applied protocol to provide IO and PO opioid-free analgesia during major surgeries for risky patients. Results: All surgeries were conducted without a shift to laparotomy or conventional opioid-based anesthesia. Group-E patients had significantly shorter PACU stays (P=0.035) and higher Aldrete scores at time of PACU discharge (P=0.023). Among Group-E patients, 5 required IO fentanyl shots and 3 patients received PO morphine shots. Group-E patients showed significantly lower PO nausea (P=0.032) and need for antiemetic therapy (P=0.005), earlier ambulation (P=0.020) and oral intake (P=0.034) and hospital discharge (P=0.014). Conclusion: Implementation of ERAS with SOUP protocols is a feasible, effective and safe anesthetic policy for high-risk patients undergoing major surgeries. The applied SOUP spared the need for opioid analgesia in about 90% of patients. The applied anesthetic policy improved immediate surgical outcomes, and reduced times for PACU discharge, ambulation, oral intake and PO hospital stay with cost reductions.

Keywords

• enhanced recovery after surgery protocol spare opioid use protocol morbid obesity laparoscopic sleeve gastrectomy