Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pain and Acute Phase Reactants.

Abstract

Postoperative pain after laparoscopic surgery has 3 components: parietal, visceral, and associated with pneumoperitoneum. Visceral pain accounts for around 30% of the total pain and is less amenable to be controlled by multimodal analgesia. The topical application of vitamin E ointment has demonstrated an anti-inflammatory effect in the local inflammatory response against surgical aggression. Vitamin E has been also associated with a reduction in postoperative pain of skin wounds. The aim of this study was to evaluate the effect of the topical application of vitamin E acetate on staple lines and anastomoses of Roux-en-Y gastric bypass, as part of a multimodal analgesia scheme within an Enhanced Recovery After Surgery (ERAS) program. A prospective randomized clinical trial was performed. Patients were divided into 2 groups: patients receiving a topical application of vitamin E on staple lines and anastomoses (G1) and patients not receiving it (G2). The primary endpoint was postoperative pain, as measured by VAS 24h after surgery. Secondary outcomes include morphine rescue needs, acute phase reactants 24h after surgery, and hospital stay. One hundred forty patients were included, 70 in each group. Postoperative pain was 10mm in G1 and 21.8mm in G2 (p < 0.001). Morphine needs within the first 24h were 2.9% in G1 and 13.2% in G2 (p = 0.026). C-reactive protein levels were significantly lower in G1 (8.7mg/dL vs 11.9; p = 0.016). Mean hospital stay was 2.1days in G1 and 2.9 in G2 (p = 0.019). Topical application of vitamin E reduces postoperative pain and acute phase reactants, allowing an earlier discharge. NCT03765827, https://www.clinicaltrials.gov.