Background

Perioperative use of opioids has been associated with opioid dependency after bariatric surgery. We evaluated the impact of a non-opioid analgesic regimen and the addition of transversus abdominis plane (TAP) block on postoperative milligram morphine equivalent (MME) use in our primary bariatric surgery population. Single center, tertiary referral, MBSAQIP-accredited bariatric surgery center

Methods

A retrospective review of a prospectively maintained database was conducted. We examined bariatric patient cohorts before and after the addition of TAP block to a multi-modal analgesia protocol. Opioid use was measured as MME both in the hospital and post-discharge in the post-implementation group. Patients on chronic narcotic therapy were excluded. Univariate and multivariate analyses were performed.

Results

There were 825 patients in the pre-implementation (Pre) and 794 patients in the post-implementation (Post) groups. Total narcotic use declined from 44 MMEs to 30 MMEs (p < 0.0001) in the Post group. Use of pre-operative non-opioids was associated with a 24 MME reduction in total narcotic use (p< 0.0001). Patients undergoing sleeve gastrectomy used an average of 10MME less narcotics post-operatively (p=0.008) than RYGB. There was a 10% reduction in the number of patients discharged home with narcotics. 40% of patients reported no pain at any point after discharge at first post-operative visit. The median outpatient MME use was 7.5.

Conclusions

Compliance with a non-opioid perioperative pain protocol combined with TAP block significantly reduced post-operative inpatient and outpatient opioid use. Outpatient pain scores were low, and most patients used less than two 5mg Oxycodone tablets.