Laparoscopic Sleeve Gastrectomy 2018

Laparoscopic Sleeve Gastrectomy-Specific Evidence

Data table: Paracetamol and NSAIDs/COX-2-selective inhibitors

Arguments for…

• One study favoured IV paracetamol compared with placebo, administered for 24 h, with significantly lower pain scores at all time points: 12, 16, 20 h (p=0.02, p=0.03, p=0.01 respectively) (n=23) (Strode 2016; LoE 1). Opioid requirements were not significantly different
• One study found no significant differences in pain scores between IM diclofenac plus IV tramadol PCA compared with fentanyl PCA (n=28) (Mansour 2013; LoE 2)

Arguments against…

• One study showed no significant difference between IV paracetamol and placebo, administered for 24 h, in terms of pain scores or opioid requirements (n=128) (Cooke 2018; LoE 1)

PROSPECT Recommendations

• Peri-operative pain management for LSG is recommended to include paracetamol (Grade A) and, unless contraindicated, an NSAID/COX-2-selective inhibitor (Grade A), administered pre-operatively or intra-operatively and continued into the postoperative period
• Although there was limited procedure-specific evidence to support the use of paracetamol and NSAIDs/COX-2-selective inhibitors, the analgesic benefits of these non-opioids are well described. They are considered “basic analgesics”

Laparoscopic Sleeve Gastrectomy-Specific Evidence

• No studies were identified in this review that specifically investigated the use of systemic opioids, although rescue opioids were used in many of the studies

PROSPECT Recommendations

• Opioids are recommended as rescue analgesia, postoperatively (Grade A) after continuation of paracetamol and unless contraindicated, an NSAID/COX-2-selective inhibitor