Massachusetts Chapter of the American College of Surgeons

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An enhanced recovery pathway for bariatric surgery using IV lidocaine decreases perioperative opioid use.
Jacqueline Paolino, Meaghan Collins, David Brams, Heather Ford, Thomas Schnelldorfer, Reuben Shin, Dmitry Nepomnayshy
Lahey Hospital, Burlington, MA, Philadelphia, PA

Background: Metabolic surgery is associated with pain and nausea in the postoperative period. Enhanced recovery after surgery (ERAS) protocols are shown to reduce length of stay and opioid requirements for bariatric patients. We implemented an ERAS protocol at our institution to standardize the perioperative care of patients, with the primary goal of reducing perioperative opioid use.
Methods: Patients who underwent primary or conversion bariatric surgery for the 3 months before ERAS implementation (n=75) and 3 months after ERAS implementation (n=60) were retrospectively evaluated.
Results: Demographics, comorbidities, and surgery type were similar between the groups. After ERAS implementation, the median milligram morphine equivalents (MME) received during surgery decreased from 65 to 37.5mg (p<0.0001), while the median MME given during their postoperative hospitalization was unchanged (14mg v 12mg, p=0.84). The percent of patients receiving no opioids for the 30 days after discharge increased from 33.3% before intervention to 60% after intervention, and the median MME prescribed for 30 days after discharge decreased from 50mg to 0mg (p<0.0001). There were 3 lidocaine reactions in the post-intervention group. Patients received significantly less toradol post-ERAS (median 105mg pre vs 60mg post, p<0.0001). There was no difference in length of stay, 30 day need for IV fluids, morbidity, ER visits, or readmissions.
Conclusion: The implementation of an ERAS program at our hospital was associated with a reduction in total opioids given intraoperatively and after discharge, without increasing morbidity.


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