ROUX-IN-Y GASTROJEJUNAL BYPASS: WHICH ANESTHETIC TECHNIQUE HAS BEST RESULTS?

Arthur Ruzzon,Lucas Augusto Prestes Gonçalves,Guilherme Wendler,Lucas Buzo,Eduardo Wendler,Igor Ruzzon,Paulo Afonso Nunes Nassif,Lais Prigol,Ilana Barrichello Torres Wendler,Caio Henrique Marchette Goveia

doi:10.1590/0102-672020200002e1530

Arthur Ruzzon, Lucas Augusto Prestes Gonçalves + Show 8 more

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https://doi.org/10.1590/0102-672020200002e1530

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Abstract

Nausea and vomiting groups x moments. As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team. To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques. Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg. The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups. Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.

Highlights

Obesity is defined as a metabolic disease in which the accumulation of adipose tissue has a proportion of body mass higher than normal, consisting of the fastest growing disease in Brazil and establishing itself as a major health problem[8].According to the Brazilian Association for the Study of Obesity and Metabolic Syndrome, the data reveal that more than 50% of the Brazilian population is overweight and in children the prevalence is 15%17
With the growing obesity epidemic, and a consequent increase in the number of procedures for its treatment and control, there is a greater interest in acquiring knowledge, experience and skills for the surgical and anesthetic management of these patients[10,21]. These involve several factors, from measures for postoperative analgesia, presence of nausea, vomiting and effective peristalsis, which contribute to lower morbidity and mortality and early discharge from hospital[4]
The sample of this clinical trial consisted of 66 patients, 34 from the clonidine group (CG) and 32 from the morphine group (MG)

Summary

Introduction

Obesity is defined as a metabolic disease in which the accumulation of adipose tissue has a proportion of body mass higher than normal, consisting of the fastest growing disease in Brazil and establishing itself as a major health problem[8].According to the Brazilian Association for the Study of Obesity and Metabolic Syndrome, the data reveal that more than 50% of the Brazilian population is overweight and in children the prevalence is 15%17. With the growing obesity epidemic, and a consequent increase in the number of procedures for its treatment and control, there is a greater interest in acquiring knowledge, experience and skills for the surgical and anesthetic management of these patients[10,21] These involve several factors, from measures for postoperative analgesia, presence of nausea, vomiting and effective peristalsis, which contribute to lower morbidity and mortality and early discharge from hospital[4]. The Enhanced Recovery after Surgery (ERAS) mentions that there are few studies on analgesic efficacy comparing adjuvants on the topic[2,19,20] The objective of this clinical trial was to analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing anesthetic technique with the use of neuroaxial opioids in reduced dose vs opioid-free neuroaxial technique

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