A randomized trial of bupivicaine pain pumps to eliminate the need for patient controlled analgesia pumps in primary laparoscopic Roux-en-Y gastric bypass

Background: The use of a bupivicaine pain pump has previously been reported to lower costs to hospitals, while providing similar pain relief to opioid-based patient controlled analgesia (PCA) pumps. However, these benefits have not been investigated in laparoscopic bariatric surgery. Methods: We prospectively randomized 40 laparoscopic Roux-en-Y gastric bypass (LRYGBP) patients into two groups. The first group received the ON-Q(R) bupivicaine pain pump placed subxiphoid and radiating in both directions caudally beneath the lowest rib. The second group was treated with a meperidine PCA, which was initiated in the PACU and discontinued at 06:00 hrs the following morning. Both groups had identical surgery, anesthesiologists, anesthesia protocol and postoperative nausea prophylaxis. Results: There were no significant differences between the groups with regard to age, sex, pain scores, nausea scores, gas pain scores, antiemetic use throughout their stay, or opioid use in the PACU. However, there was a dramatic decrease in opioid use between the two groups over the time interval from leaving the PACU to 06:00 hrs (meperidine by PCA mean 217 mg vs ON-Q(R) 129 mg meperidine equivalents, P = 0.008). Conclusions: The use of a bupivicaine pain pump offers the opportunity to dramatically reduce the use of opioids postoperatively in all bariatric patients by eliminating PCA. This change could potentially reduce the incidence of respiratory failure from oversedation, while offering the same levels of pain control.