COMPARISON OF MULTIMODAL PERIOPERATIVE ANALGESIA TO THORACIC EPIDURAL ANALGESIA AFTER OPEN BARIATRIC SURGERY

Background: Epidural catheter insertion in morbid obese patients can be timeconsuming and technically difficult. So, there is growing interest for less demanding analgesia modes after bariatric surgeries. Methods: Sixty ASA II-III morbidly obese patients undergoing elective open bariatric operations were allocated into 3 groups (n=20; each) according to postoperative analgesia method after receiving standard general anesthesia: Group-A: multimodal analgesia [pre-incision and pre-extubation supplemental field infiltration with 30ml bupivacaine 0.25% and postoperative intravenous morphine]. Group-B: intraoperative thoracic epidural analgesia with postoperative continuous infusion of bupivacaine 0.1%, fentanyl 2µg/ml combination.Group-C: postoperative intravenous morphine only. Evaluation include visual analogue score (VAS) morphine consumption, neuroendocrine stress response (serum Cortisol and blood glucose levels), hemodynamics, blood gases, analgesia related side effects, ambulation time, and intestinal motility-return time. Results: Groups were comparable in demographic data. Group-A and Group-B has a comparable VAS, hemodynamics, blood gases, analgesia related side effects, blunting stress response, and ambulation time when compared to Group-C. Group-B patients spent more time in theatre but return of gastrointestinal function occurred earlier in them. Conclusion: wound infiltration as part of a multimodal regimen offers a simple, safe, and inexpensive alternative to epidural analgesia after open bariatric surgery in morbid obese patients.