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Canadian Journal of Anesthesia 51:276 (2004)
© Canadian Anesthesiologists' Society, 2004

Correspondence

REPLY

Thomas Schricker, MD PhD and Steven Backman, MD PhD

Montreal, Quebec

We appreciate Drs. Lang’s and Arraf’s interest in our article on different pain treatment strategies after bariatric surgery. All the methodological limitations including "retrospective nature of the study," "selection bias," and "lack of adequate surveillance data" represent valid concerns and were accordingly addressed in our article.1 It was not the purpose of our manuscript to discourage the use of either epidural analgesia in morbidly obese patients or the initiation of prospective studies but rather to emphasize that iv patient controlled analgesia (PCA) with morphine is an acceptable strategy to achieve adequate pain control after open gastric bypass surgery. Moreover, its ease of use must be factored in the risk-benefit comparison when choosing a method for postoperative analgesia control in this challenging type of patient. Although in our institution we enthusiastically encourage the use of thoracic epidural catheters for upper abdominal procedures one has to be careful with statements such as "placing epidural catheters at T11–12, L1 levels for upper abdominal surgery is a formula for failure." Notwithstanding the fact that reliable and correct identification of the exact spinal segment may be difficult, particularly in the morbidly obese patient, no prospective data in this unique patient population are available yet to substantiate the authors’ statement who "believe that epidural analgesia" (using local anesthetic and narcotics) "is superior to analgesia provided by iv PCA narcotic."

Reference

1 Charghi R, Backman S, Christou N, Rouah F, Schricker T. Patient controlled iv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia. Can J Anesth 2003; 50: 672–8.[Abstract/Free Full Text]


Related articles in CJA:

Analgesia in bariatric patients following upper abdominal surgery
Scott A. Lang and John Arraf
CJA 2004 51: 276. [Full Text]  




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