No abstract

Summary Peri‐operative lidocaine infusion warrants investigation in bariatric surgery because obese patients present different physiological and pharmacological risks. This single‐centre, prospective, randomised double‐blind placebo‐controlled study enrolled obese patients scheduled for laparoscopic bariatric surgery using an enhanced recovery protocol. Patients received either lidocaine (bolus of 1.5 mg.kg−1, then a continuous infusion of 2 mg.kg−1.h−1 until the end of the surgery, then 1 mg.kg−1.h−1 for 1 h in the recovery area) or identical volumes and rates of 0.9% saline. The primary outcome was the consumption of the equivalent of oxycodone consumption over the first 3 postoperative days. Secondary outcomes were: postoperative pain; incidence of nausea and vomiting; bowel function recovery; and lengths of stay in the recovery area and in hospital. Plasma concentrations of lidocaine were measured. On the 178 patients recruited, data were analysed from 176. The median (IQR [range]) equivalent intravenous oxycodone consumption was 3.3 mg (0.0–6.0 [0.0–14.5]) and 5.0 mg (3.3–7.0 [3.3–20.0]) in the lidocaine and saline groups, respectively (difference between medians (95%CI): 1.7 (0.6–3.4) mg; p = 0.004). Length of stay in the recovery area, postoperative pain, nausea and vomiting, day of recovery of bowel function, and length of stay in hospital were not different between groups. Mean (SD) lidocaine plasma concentrations were 2.44 (0.70) µg.ml−1 and 1.77 (0.51) µg.ml−1 at the end of surgery and 1 hour after the end of infusion, respectively. Lidocaine infusion during bariatric surgery resulted in a clinically non‐relevant difference in postoperative oxycodone consumption.

Background To identify preoperative risk factors for discharge failure beyond postoperative day two (POD‐2) in bariatric surgery ERAS program in a tertiary referral center. Methods all consecutive patients who underwent laparoscopic bariatric treated in accordance with ERAS protocol between January 2017 and December 2019 were included. Two groups were identified, failure of early discharge (> POD‐2) (ERAS‐F) and success of early discharge (≤ POD‐2) (ERAS‐S). Overall postoperative morbidity, unplanned readmission rates were analyzed at POD‐30 and POD‐90, respectively. Multivariate logistic regression was performed to determine the independent risk factors for LOS > 2 days (ERAS‐F). Results A total of 697 consecutive patients were included, 148 (21.2%) in ERAS‐F group and 549 (78.8%) in ERAS‐S group. All postoperative complications at POD 90, whether medical or surgical were significantly more frequent in ERAS‐F group than in ERAS‐S group. Neither readmission nor unplanned consultations rates at POD 90 were significantly different between both groups. History of psychiatric disorder (p = 0.01), insulin‐dependent diabetes (p < 0.0001), use of anticoagulants medicine (p < 0.00001), distance to the referral center > 100 km (p = 0.006), gallbladder lithiasis (p = 0.02), and planned additional procedures (p = 0.01) were independent risk factors for delayed discharge beyond POD‐2. Conclusions One in five patients with bariatric surgery failed to discharge earlier despite the ERAS program. Knowledge of these preoperative risk factors would allow us to identify patients who need more recovery time and a tailored approach to the ERAS protocol.