The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Abstract

Background: This study aimed to compare the efficacy and safety of combined intraoperative tramadol with pethidine versus pethidine alone and to assess their impact on post-operative pethidine requirements after laparoscopic sleeve gastrectomy (LSG).Methods and Results: This multicenter cohort research included 400 patients with morbid obesity who had LSG between January 2021 and December 2022. The patients included in the study were allocated to one of two treatment groups that were not randomized. Group A received only 1 mg/kg of pethidine before extubation. , while Group B got 1 mg/kg tramadol given when the surgeon started a gastric division with 1 mg/kg of pethidine before extubation. Doses were based on the patient’s ideal body weight.The mean VAS pain score at 1, 3, 6, 12, and 24h after LSG was significantly reduced in group B (4.2, 2.89, 2.03, 1.69, and 0.26, respectively) compared to group A (5.1, 4.16, 3.21, 2.78, and 0.44). Post-operative nausea and vomiting (PONV) were higher in group A at 3 and 6 h after LSG. Opioid consumption in the post-operative period was less in Group B than in Group A. There was a significant reduction in the requirement for on-demand metoclopramide and ondansetron in group B. Oxygen desaturation (<92) significantly developed in group A after surgery and was managed using an oxygen mask. Post-operative bradycardia was significantly observed in group B after LSG.Conclusions: Intraoperative tramadol with pethidine provides superior post-operative analgesia and safety over Intraoperative pethidine alone.