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Patient controlled iv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

[L’analgésie iv autocontrôlée est une stratégie de traitement de la douleur acceptable chez les patients atteints d’obésité morbide qui subissent un pontage gastrique. Une comparaison rétrospective avec l’analgésie péridurale]

Roshanak Charghi, MD^*, Steven Backman, MD PhD^*, Nicolas Christou, MD PhD, Fabrice Rouah, MSc and Thomas Schricker, MD PhD^*

^* From the Departments of Anesthesia,
and Surgery, Royal Victoria Hospital;
and the Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada.

Address correspondence to: Dr. Thomas Schricker, Department of Anesthesia, McGill University, Royal Victoria Hospital, Room S5.05, 687 Pine Ave West, Montreal, Quebec H3A 1A1, Canada. Phone: 514-842-1231, ext. 34880; Fax: 514-843-1723; E-mail: thomas.schricker{at}mcgill.ca

Purpose: To examine the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. We retrospectively compared the postoperative periods in all patients undergoing this procedure in our institution between November 1999 and November 2001.

Methods: According to their perioperative pain treatment, patients were assigned to a PCA group (with iv morphine) or an epidural analgesia group, in which patients received either intermittent doses of morphine or continuous infusions of bupivacaine/fentanyl. Study endpoints included quality of pain control, incidence of cardiovascular and respiratory complications, analgesia related side effects, time to ambulation and first flatus, length of hospital stay, and wound infections.

Results: Data from 86 patients were analyzed with 40 patients in the PCA group and 46 patients in the epidural group. Groups were similar with respect to age, body mass index, and gender. The type of analgesia did not affect the quality of pain control at rest, the frequency of nausea and pruritus, the time to ambulation and return of gastrointestinal function, and the length of hospital stay. Patients receiving epidural analgesia had a greater risk of wound infection than subjects with PCA (epidural group: 39%, PCA group: 15%, P = 0.01).

Conclusion: We conclude that in grossly obese patients undergoing gastric bypass surgery PCA with iv morphine is an acceptable strategy for pain management and may confer some advantages when compared to epidural analgesia.

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