Case report

Multimodal approaches with or without ERAS protocols have demonstrated benefits in bariatric surgery

Protocol implementation can positively impact recovery and costs1-6

  • 50% shorter LOS
  • 40% to 61% fewer fewer opioids at 48 hours
  • 86% fewer patients with itching, demonstrating an improvement in ORAEs
  • Earlier ambulation, which may reduce the risk of VTE (PE and DVT)
  • 50% fewer cases of respiratory dysfunction in patients not taking morphine
  • 96% of patients without postoperative nausea/vomiting
  • 19-hour earlier return of bowel sounds and flatus

The ASA supports the use of opioid-minimizing pain management strategies after bariatric surgery

  • “Because of the high incidence of obstructive sleep apnea (OSA) in obese patients and other studies showing that morbidly obese patients have increased perioperative airway obstruction and desaturations even without OSA, the focus with regard to pain management has to be on opioid-sparing multimodal approaches.”7

    - Best Practice & Research: Clinical Anaesthesiology, 2011

  • “…regional analgesic techniques should be considered to reduce or eliminate the requirement for systemic opioids in patients at increased perioperative risk from OSA.”8

    “For superficial procedures, consider the use of local anesthesia…”8

    - 2014 Practice Guidelines for OSA

DVT, deep vein thrombosis; ERAS, enhanced recovery after surgery; LOS, length of stay; ORAE, opioid-related adverse event; PE, pulmonary embolism; VTE, venous thromboembolism; ASA,American Society of Anesthesiologists.

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