Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients
Dabour, Y., Elnoury, A., Afifi, H., Daoud, A. (2023). Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients. EKB Journal Management System, 6(2), 808-826. doi: 10.21608/svuijm.2023.240934.1713
Yehya Shahin Dabour; Ahmed Said Elnoury; Haitham S. Afifi; Ahmed Abouelgheit Daoud. "Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients". EKB Journal Management System, 6, 2, 2023, 808-826. doi: 10.21608/svuijm.2023.240934.1713
Dabour, Y., Elnoury, A., Afifi, H., Daoud, A. (2023). 'Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients', EKB Journal Management System, 6(2), pp. 808-826. doi: 10.21608/svuijm.2023.240934.1713
Dabour, Y., Elnoury, A., Afifi, H., Daoud, A. Spare Opioid Use Protocol Improved the Outcomes of the Enhanced Recovery after Surgery Protocol for Patients Undergoing Laparoscopic Sleeve Gastrectomy for Morbid Obese Patients. EKB Journal Management System, 2023; 6(2): 808-826. doi: 10.21608/svuijm.2023.240934.1713

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

SVU-International Journal of Medical Sciences
Volume 6, Issue 2, July 2023, Page 808-826  XML PDF (363.96 K)
Document Type: Original research articles
DOI: 10.21608/svuijm.2023.240934.1713
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Authors
Yehya Shahin Dabour email orcid 1; Ahmed Said Elnoury1; Haitham S. Afifi2; Ahmed Abouelgheit Daoud1
1Department of Anesthesia & ICU, Faculty of Medicine, Benha University, Benha, Egypt.
2Department of General Surgery; Faculty of Medicine, Benha University, Benha, Egypt
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
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