Modified intermittent subfascial wound infiltration with local anaesthetic after open gastric bypass (wound infiltration aftrer gastric bypass)

Abstract

Introduction: Infiltration of the surgical wound with local anesthetic through a multi-holed catheter is widely applied as a component of multimodal postoperative analgesia, but there is little evidence of its use in bariatric surgery. A case of modified intermittent subfascial wound infiltration in a morbidly obese patient after open gastric bypass surgery is reported. Case report: A 57-year-old female morbidly obese patient underwent an open gastric bypass. Given the severity of obstructive sleep apnea syndrome and chronic obstructive pulmonary disease as well as limited availability of noninvasive ventilation, the anesthetic plan had to be tailored to minimize opioid consumption in postoperative period. Two multi-holed epidural catheters were placed between peritoneum and muscular fascia along the length of the wound. At the end of the surgery, subfascial and subcutaneous wound infiltration with 20 ml of 0.5% bupivacaine with 5 µg/ml adrenaline was performed. For 72h after surgery 5 ml of 0.25% Bupivacaine with 2 µg/ml Adrenaline were delivered q.i.d. through each catheter. Analgesia was supplemented with intravenous paracetamol 1 g q.i.d, and metamizole 2.5 g b.i.d. Tramadol was administered once for breakthrough pain after admission to intensive care unit. Pain intensity during 72h after surgery was 1-2 at rest and 3 during mobilization on numerical pain scale (NPS 1-10). Postoperative recovery was uneventful. Conclusion: Modified intermittent subfascial wound infiltration with local anesthetic applied through two epidural catheters as a part of multimodal analgesia with minimal usage of opioids provided effective pain relief for morbidly obese patient after open gastric bypass.

Keywords

• gastric bypass
• obesity
• postoperative pain
• wound infiltration