• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Reduction of opioid use after implementation of Enhanced Recovery After Bariatric Surgery (ERABS).

Pearl K Ma, MD1, Aaron Lloyd, MPH2, Morgan Mcgrath, MAS2, Alice Jackson, RN2, Keith Boone, MD1, Kelvin Higa, MD1. 1University of California-San Francisco Fresno, 2Fresno Heart and Surgical Hospital

Enhanced recovery after surgery (ERAS) protocols have been well described in lower gastrointestinal surgery literature to decrease postoperative physiologic stress, decrease pain with increased mobility, and reduction in length of stay (LOS). However, implementation of ERAS in bariatric surgery has inconsistent results, especially as protocols varies immensely from each program with a predominant focus on reduction of length of stay. Our focus in implementing enhance recovery after bariatric surgery (ERABS) protocols were aimed at decreasing postoperative pain and therefore reducing opioid use.

Methods: Retrospective review of patients who underwent laparoscopic primary bariatric surgeries of either Roux-en-Y gastric bypass or sleeve gastrectomy at single high volume center between June 2016 to October 2017.

3 groups were examined with “Control” group defined as without any protocol changes. “Exparel” group without protocol changes except intraoperative injection of liposomal bupivacaine (Exparel©). ERABS/Exparel group implemented ERABS protocol (Figure 1). Postoperative course, narcotic use, and 30-day outcome rates were analyzed using combination of t-test and Mann-Whitney U.

 Figure 1.

Results: 1314 patients were analyzed. Table 1 describes the addition of Exparel without ERABS. Narcotic requirements were measured as morphine equivalent units (MEU). Overall MEU was decreased, improved patient experience and better pain level scores. With the addition of ERABS, a significantly greater response was found even when compared to control/Pre-Exparel group and even Exparel alone group with a 60% reduction in narcotic use in the hospital, with more patients (10% versus 0% of patients in control group, p <0.05) not requiring any narcotics postoperatively.

Table 1.

Table 2. describes changes from in pain scores of 1-10, length of stay, and total narcotic requirements. Decreased readmission rates, reoperation rates within 30 day outcomes were also examined between groups in Table 3.

Table 2.

Table 3.

Conclusions: Implementation of ERABS significantly reduced postoperative narcotic use and improved pain scores with more effect found the addition of intraoperative use of Exparel©.   Although there was no decrease in our already low rates of length of stay, 30 day readmission rate and reoperation rates were significantly reduced in primary bariatric surgeries with ERABS protocol.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 93472

Program Number: S106

Presentation Session: Bariatric III – Optimizing Care and Pathways

Presentation Type: Podium

283

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons