Preoperative Dexamethasone to Improve Quality of Recovery After Laparoscopic Bariatric Surgery
Condition: Anesthesia; Analgesia; Acute Pain
MeSH terms: Acute Pain
Study type: Observational [Patient Registry]

Summary: 
      In the obese patient, adequate pain relief in the postoperative period is an important
      parameter that affects patient comfort and hospital stay. Increasing patient comfort and
      recovery quality can be achieved by avoiding undesirable effects such as nausea and vomiting,
      as well as analgesia. In our study, our aim is to evaluate the effect of dexamethasone added
      to multimodal analgesia on postoperative patient comfort in the obese patient group with a
      40-item scale.
    

Detailed description: 
      Postoperative pain prolongs hospital stay, delays wound healing, increases infection rates,
      and increases the incidence of drug side effects due to the use of systemic pain relievers
      (especially opioids).

      Good pain control facilitates respiratory effort, allows the patient to perform respiratory
      exercises and cough to correct the increased thoracic fat mass and impaired respiratory
      mechanics due to anesthesia. The patient without pain is mobilized early and discharged
      early.

      Our aim is to evaluate the effect of dexamethasone added to multimodal analgesia on
      postoperative patient comfort in the obese patient group with a 40-item scale.

      Patients will be divided in to two groups (group D and group C):

      Group D (Dexamethasone Group):

      Patients who used/applied dexamethasone before bariatric surgery were included in this group.

      Group C(Control Group):

      Patients who did not use dexamethasone or steroid-derived drugs were included in this group.

      The patients included in the study were evaluated with the 40-item recovery quality scale
      (QoR-40) 24 hours after the operation.

      İn addition all patients will be administered iv morphine pca (patient controlled analgesia)
      for the first 24 hours postoperatively
    

Intervention name(s): Group D; Group C
Intervention type(s): Drug; Drug
Intervention description(s): Patients who received 8 mg dexamethasone before bariatric surgery will be included in this group.
Multimodal analgesia protocol is applied to all patients undergoing bariatric surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg, tramadol 100mg after induction of general anesthesia, and iv morphine (0.05mg/kg/IBW) intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv pca of 0,4mg/ml morphine (the bolus dose is 1mg, the lock-in time of 15 minutes, the 4-hour limit is adjusted to be 40% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥3) 0.5 mg/kg tramadol is administered to patients. For postoperative nausea and vomiting prophylaxis, patients are routinely administered ondansetron 4 mg IV 20 minutes before extubation.; Patients not administered dexamethasone will be included in this group.
Multimodal analgesia protocol is applied to all patients undergoing bariatric surgery in our clinic. According to this protocol, patients are administered iv tenoxicam 20mg, tramadol 100mg after induction of general anesthesia, and iv morphine (0.05mg/kg/IBW) intraoperatively. Postoperative analgesia: iv paracetamol 1gr every 8 hours and iv pca of 0,4mg/ml morphine (the bolus dose is 1mg, the lock-in time of 15 minutes, the 4-hour limit is adjusted to be 40% of the calculated total dose). In cases where rescue analgesia is required (VAS score ≥3) 0.5 mg/kg tramadol is administered to patients. For postoperative nausea and vomiting prophylaxis, patients are routinely administered ondansetron 4 mg IV 20 minutes before extubation.
Other intervention name(s): dexamethasone group; control group
Intervention MeSH terms: Dexamethasone
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients with BMI > 30 undergoing elective laparoscopic sleeve gastrectomy (LSG)
      
Keywords: dexamethasone; quality of recovery-40; acute pain scores; morphine consumption