BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been extensively proven in lower gastrointestinal surgery to decrease postoperative physiologic stress and length of stay (LOS). ERAS in bariatric surgery (ERABS) varies immensely from each program with inconsistent results with a predominant goal of reducing LOS. Our focus in implementing enhanced recovery after bariatric surgery (ERABS) protocols is aimed at reducing postoperative pain and opioid use. METHODS This is a retrospective review of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG) at a single high-volume center from June 2016 to October 2017. Patients on previous standard protocol were categorized into "Pre-Liposomal Bupivacaine (LB) group." After routine use of Exparel™, patients were grouped into "LB group." After ERABS protocol was initiated, patients were categorized into "ERABS/LB group." Postoperative opioids were converted to morphine equivalents units (MEU); pain scores, LOS, and 30-day outcomes were analyzed using combination of t test and Mann-Whitney U. RESULTS A total of 1340 patients were included in the study: 304 patients in pre-LB group; 754 patients in LB group, and 282 patients in ERABS/LB group. Total hospital opioid use was 58.6 MEU in pre-LB, 40.8 MEU in LB, and 23.8 MEU in ERABS/LB (p = 0.01). ERABS/LB group found a 59.5% decline in MEU requirements compared to pre-LB (p < 0.001) and 44.9% of patients did not require any additional narcotics on the floor compared to 0% in pre-LB group (p < 0.001). ERABS/LB LOS was an average of 1.48 days compared to 1.54 days in pre-LB group (p = 0.03) with an overall decrease of 3.74% in readmission rates (p = 0.03). CONCLUSIONS Implementation of ERABS significantly reduced postoperative opioid use, LOS, and readmissions. With ERABS, a more profound effect was observed than simply adding Exparel™ to preexisting protocols. Almost half of these patients did not require narcotics while recovering on the surgical floor. More studies are required to assess the true effect of ERABS without use of Exparel™.

中文翻译：

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减肥手术（ERABS）实施增强恢复后，减少阿片类药物的使用。

背景技术已经在下消化道手术中广泛地证实了增强的术后恢复（ERAS）方案以降低术后的生理压力和住院时间（LOS）。减肥手术（ERABS）中的ERAS与每个程序的差异很大，结果不一致，其主要目标是降低LOS。我们致力于实现减肥手术（ERABS）协议后的增强恢复力，旨在减少术后疼痛和阿片类药物的使用。方法这是一项回顾性研究，回顾性分析了2016年6月至2017年10月在单个大型医院接受腹腔镜Roux-en-Y胃搭桥术（RYGB）或袖式胃切除术（VSG）的患者。以前采用标准治疗方案的患者被分类为“脂质体前布比卡因（LB）组。” 常规使用Exparel™后，将患者分为LB组。03），再录入率整体下降3.74％（p = 0.03）。结论ERABS的实施显着减少了术后阿片类药物的使用，LOS和再入院率。与ERABS相比，观察到的影响要大得多，而不仅仅是简单地将Exparel™添加到现有协议中。这些患者中几乎有一半在手术地板上康复时不需要麻醉剂。在不使用Exparel™的情况下，需要更多的研究来评估ERABS的真实效果。