Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pa
- PDF / 272,152 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 139 Views
ORIGINAL CONTRIBUTIONS
Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pain and Acute Phase Reactants Jaime Ruiz-Tovar 1
&
Alejandro Garcia 1 & Carlos Ferrigni 1 & Manuel Duran 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose 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 Rouxen-Y gastric bypass, as part of a multimodal analgesia scheme within an Enhanced Recovery After Surgery (ERAS) program. Methods 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 24 h after surgery. Secondary outcomes include morphine rescue needs, acute phase reactants 24 h after surgery, and hospital stay. Results One hundred forty patients were included, 70 in each group. Postoperative pain was 10 mm in G1 and 21.8 mm in G2 (p < 0.001). Morphine needs within the first 24 h were 2.9% in G1 and 13.2% in G2 (p = 0.026). C-reactive protein levels were significantly lower in G1 (8.7 mg/dL vs 11.9; p = 0.016). Mean hospital stay was 2.1 days in G1 and 2.9 in G2 (p = 0.019). Conclusion Topical application of vitamin E reduces postoperative pain and acute phase reactants, allowing an earlier discharge. Trial Registration NCT03765827, https://www.clinicaltrials.gov. Keywords Visceral pain . Vitamin E . Staple lines . Anastomosis
Introduction In the last decade, the number of bariatric procedures has exponentially grown. The implementation of the laparoscopic approach has been one of the main factors to determine this growth, as this minimally invasive approach is associated with lower complication rates, shorter hospital stay, and earlier reincorporation to normal activities than after open procedures [1]. Laparoscopic surgery is part of Enhanced Recovery After Surgery (ERAS) protocols, which altogether aim to reduce the impact of the surgical
* Jaime Ruiz-Tovar [email protected] 1
Bariatric and Metabolic Surgery Unit, Rey Juan Carlos University Hospital, Gladiolo, s/n, 28933 Madrid, Spain
damage [2]. Consequently, laparoscopic techniques are associated with lower postoperative pain than conventional approaches. Notwithstanding, the optimal management of postoperative pain still remains a major challenge in patients with obesity, as it might l
Data Loading...
