Skip to main content
SpringerLink
Log in

Safety and Efficacy of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used for Analgesia After Bariatric Surgery: A Retrospective Case-Control Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Non-steroidal anti-inflammatory drugs (NSAIDs) are cornerstone in multimodal analgesia protocols. This point is of great value in morbidly obese patients due to the high prevalence of restrictive pulmonary disease and obstructive sleep apnea. The aim of this study was to test the hypothesis that NSAIDs do not increase acute bariatric surgery complications while optimizing postoperative analgesia.

Methods

Databases of two medical centers were retrospectively reviewed to find all patients who underwent bariatric surgery between 1 January 2017 and 31 December 2017. Inclusion criteria were BMI greater than 30 kg/m2 and age of 16–75 years old. Patients who suffered from severe organ failure or coagulation disorders were excluded. Patient’s demographics, obesity-related diseases (diabetes, hypertension, dyslipidemia), postoperative pain scores, and morphine consumption in PACU, as well as early and late surgical complications, were collected. Patients included from the first institution (where NSAIDs analgesia was prohibited: control group) were compared to patients from the second institution (where NSAIDs analgesia was mandatory: case group).

Results

The study population included 270 patients, 134 in the control group, and 136 in the case group. NSAIDs usage produced better analgesia with significant reduction in morphine consumption and PACU length of stay. Also, incidence of surgical complications was the same in the two groups.

Conclusions

NSAIDs administration do not increase postoperative complication rate after bariatric surgery. Although NSAID administration provided better analgesia and shorter PACU stay, future prospective studies are needed to confirm these encouraging results and to evaluate their impact on postoperative rehabilitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Arroyo-Johnson C, Mincey KD. Obesity epidemiology worldwide. Gastroenterol Clin N Am. 2016;45(4):571–9.

    Article  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. Jama. 2004;292(14):1724–37.

    Article  CAS  PubMed  Google Scholar 

  3. Hernandez J, Boza C. Novel treatments for complications after bariatric surgery. Ann Surg Innov Res. 2016;10:3.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Govindarajan R, Ghosh B, Sathyamoorthy MK, et al. Efficacy of ketorolac in lieu of narcotics in the operative management of laparoscopic surgery for morbid obesity. Surg Obes Relat Dis. 2005;1(6):530–5. discussion 535-6

    Article  PubMed  Google Scholar 

  5. McDaid C et al. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess. 2010;14(17):1–153. iii-iv

    Article  CAS  PubMed  Google Scholar 

  6. Whistance RN, Forsythe RO, McNair AGK, et al. A systematic review of outcome reporting in colorectal cancer surgery. Color Dis. 2013;15(10):e548–60.

    Article  CAS  Google Scholar 

  7. Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006;332(7553):1302–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Coblijn UK, Lagarde SM, de Castro SMM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25(5):805–11.

    Article  PubMed  Google Scholar 

  9. Sverden E et al. Risk factors for marginal ulcer after gastric bypass surgery for obesity: a population-based cohort study. Ann Surg. 2016;263(4):733–7.

    Article  PubMed  Google Scholar 

  10. Warner TD, Giuliano F, Vojnovic I, et al. Nonsteroid drug selectivities for cyclo-oxygenase-1 rather than cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: a full in vitro analysis. Proc Natl Acad Sci U S A. 1999;96(13):7563–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Collaborative ST. Impact of postoperative non-steroidal anti-inflammatory drugs on adverse events after gastrointestinal surgery. Br J Surg. 2014;101(11):1413–23.

    Article  CAS  Google Scholar 

  12. Marret E, Kurdi O, Zufferey P, et al. Effects of nonsteroidal antiinflammatory drugs on patientcontrolled analgesia morphine side effects: metaanalysis of randomized controlled trials. Anesthesiology. 2005;102:1249–60.

    Article  CAS  PubMed  Google Scholar 

  13. Xinyu Zhang PTD, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrology. 2017;18:256.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Curiel RV, Katz JD. Mitigating the cardiovascular and renal effects of NSAIDs. Pain Med. 2013;14(Suppl 1):S23–8.

    Article  Google Scholar 

  15. Okamura A, Watanabe M, Imamura Y, et al. Preoperative glycosylated hemoglobin levels predict anastomotic leak after esophagectomy with cervical esophagogastric anastomosis. World J Surg. 2017;41(1):200–7.

    Article  PubMed  Google Scholar 

  16. Ding N, Mao Y, He J, et al. Experiences in the management of anastomotic leakages and analysis of the factors affecting leakage healing in patients with esophagogastric junction cancer. J Thorac Dis. 2017;9(2):386–91.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vorwald P et al. Laparoscopic Roux-en-Y gastric bypass after open vertical banded gastroplasty in patient with severe GERD. Obes Surg. 2017:1–1.

  18. Nguyen NT, Ho HS, Palmer LS, et al. A comparison study of laparoscopic versus open gastric bypass for morbid obesity. J Am Coll Surg. 2000;191(2):149–55. discussion 155-7

    Article  CAS  PubMed  Google Scholar 

  19. White S, Han SH, Lewis C, et al. Selective approach to use of upper gastroesophageal imaging study after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4(2):122–5.

    Article  PubMed  Google Scholar 

  20. Burton TP, M. A, Soop M. Nonsteroidal antiinflammatory drugs and anastomotic dehiscence in bowel surgery: systematic review and meta-analysis of randomized, controlled trials. Dis Colon Rectum. 2013;56:126–34.

    Article  PubMed  Google Scholar 

  21. Gorissen KJ, B. D, Berghmans T, et al. Risk of anastomotic leakage with non-steroidal antiinflammatory drugs in colorectal surgery. Br J Surg. 2012;99:721–7.

    Article  CAS  PubMed  Google Scholar 

  22. Ferraz AA, Cowles VE, Condon RE, et al. Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg. 1995;61(12):1079–83.

    CAS  PubMed  Google Scholar 

  23. Lyons, M.M., et al. Symptomless multi-variable apnea prediction index assesses obstructive sleep apnea risk and adverse outcomes in elective surgery. Sleep, 2017 40(3).

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Crtitical Care and Pain Management, Hôtel Dieu de France hospital, Saint Joseph university school of medicine, P.O.Box 11-5076, Beirut, 1107 2180, Lebanon

    Hicham Abou Zeid, Rita Kallab, Hisham Jabbour, Christine Dagher & Nicole Naccache

  2. Hôtel Dieu de France Hospital, Alfred NACCACHE Blvd, Ashrafieh, P.O.Box 166830, Beirut, Lebanon

    Hicham Abou Zeid

  3. Department of Anesthesia, Monseigneur Cortbawi Institute, orange zone, road 3, Adma, 00000, Lebanon

    Marie Antoinette Najm

  4. Department of Surgery, Hôtel Dieu de France hospital, Saint Joseph university school of medicine, P.O.Box 11-5076, Beirut, 1107 2180, Lebanon

    Roger Noun

  5. Department of Surgery, Monseigneur Cortbawi Institute, orange zone, road 3, Adma, 00000, Lebanon

    Fadi Sleilati

  6. Department of Pneumology, Hôtel Dieu de France hospital, Saint Joseph university school of medicine, P.O.Box 11-5076, Beirut, 1107 2180, Lebanon

    Salim Chucri

  7. Department of Statistics, Saint Joseph university school of medicine, P.O.Box 11-5076, Beirut, 1107 2180, Lebanon

    Ghassan Sleilaty

Authors
  1. Hicham Abou Zeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rita Kallab
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie Antoinette Najm
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hisham Jabbour
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roger Noun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fadi Sleilati
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Salim Chucri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christine Dagher
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ghassan Sleilaty
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nicole Naccache
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hicham Abou Zeid.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abou Zeid, H., Kallab, R., Najm, M.A. et al. Safety and Efficacy of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used for Analgesia After Bariatric Surgery: A Retrospective Case-Control Study. OBES SURG 29, 911–916 (2019). https://doi.org/10.1007/s11695-018-3608-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3608-y

Keywords

Search

Navigation