High Dose Opioid Analgesia Use Prior To Laparoscopic Gastric Stimulator Placement Reduces Likelihood of Clinical Success

Mena Boules, MD, Hideharu Shimizu, MD, Andrea Zelisko, MD, Kevin El-Hayek, MD, Maged K Rizk, MD, Matthew Kroh, MD. Cleveland Clinic Foundation.

Introduction: Gastroparesis is a chronic, common, and costly disorder for which medical therapy is often unsuccessful. Gastric electrical stimulation (GES) has been used to treat refractory cases however response is variable and difficult to predict. This study aims to asses whether pre-operative opioid analgesics (OA) use affects clinical success of GES.

Methods: Records of 128 patients, who underwent laparoscopic GES placement from March 2001 to September 2012, were analyzed retrospectively. Data collected included demographics, surgical outcomes and clinical parameters. Pre- and post-operative opioid analgesic dosing (No=0 morphine equivalents (ME)/day, Low=0-40 ME/day, Mid=41-80 ME/day, High>80 ME/day), as well as clinical symptom assessment was collected for up to three years post-operatively. Clinical success was defined as 1) OA reduction of >50%, 2) maintenance of weight, or 3) symptom improvement. Descriptive statistics were computed for all factors. A P < 0.05 was considered statistically significant.

Results: 53 patients were on OA pre-operatively compared to 69 patients who were not. Patients not on OA pre-operatively were less likely to be on OA post-operatively (p=0.005), however there were no differences in weight or symptom improvement. Sub-group analysis of the 53 patients on OA demonstrated significant improvement in clinical symptoms in the low-morphine cohort compared to the mid-morphine cohort (p=0.02), and OA dosing post-operatively in the low morphine cohort diminished significantly compared to mid- and high-morphine cohort (p=0.032). There was no significant different in weight.

Conclusion: OA dosing preoperatively significantly effect clinical success of GES placement. Criteria for GES placement may need to take OA dosing into consideration.

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