Research Article

Multimodal Anesthesia/Analgesia Model in Obese Patients Undergoing Open Abdominal Surgery

Author: S Vorotyntsev

Background: Patients with concomitant obesity show increased sensitivity to opiod-induced sedation and respiratory depression. To reduce the perioperative opioid load in bariatric surgery, various multimodal anesthetic techniques are used. The purpose is to check the effectiveness of our own perioperative multimodal anesthesia/analgesia protocol for obese patients undergoing open abdominal surgery. Materials and methods: A prospective, single-centered study included 54 patients with BMI>30 kg/m2 divided into two groups. In group 1 (MAA-group, n=30), a multimodal anesthesia/analgesia protocol was used (inhaled anesthesia with sevoflurane + epidural analgesia with lidocaine/bupivacaine + low doses of ketamine + low doses of clonidine + fentanyl). In group 2 (TIVA-group, n=24) total intravenous anesthesia was performed with propofol and fentanyl, and trimeperidine was used for postoperative analgesia. Endpoint comparative values included intraoperative hemodynamic stability, extubation time, general intra- and post-operative need for opioid analgesia, mobility of patients, return to enteral feeding and degree of analgesic comfort. Statistical analysis was carried out by software Statistica for Windows version 6.0. Results: Intraoperative patients in MAA-group were more likely to use phenylephrine than in TIVA-group patients (18 cases vs 2 cases, p<0.05), but less fentanyl (0.8 (0.6-0.9) mg vs 1.3 (1.1-1.5) mg respectively, p<0.05). Extubation time in MAA-group was 13 (10-15) minutes, and in the TIVA-group - 35 (20-45) min. (p<0.05). After surgery, patients in MAA-group required less trimeperidine than patients in TIVAgroup (30 (20-60) mg versus 60 (40-80) mg, respectively, p<0.05), earlier activated and began to consume food (24 h vs 48 h, respectively, p <0.05). In MAA-group, 100% of respondents showed satisfaction with the obtained analgesic regimen at the “excellent-good” level, while in TIVA-group, 15 (62.5%) of respondents noted the level of comfort as “good-satisfactory” and three patients (12.5%) of this group were completely dissatisfied with postoperative analgesia (p<0.05). Conclusion: Multimodal anesthesia/analgesia based on low flow anesthesia with sevoflurane, thoracic epidural analgesia with lidocaine, intravenous ketamine and clonidine proved to be an effective method of perioperative pain management in obese patients undergoing open abdominal surgery, that decreases the need for post-operative opioid use and improves the analgesic patients’ comfort