The investigators wish to standardise and optimise perioperative care for consecutive patients undergoing laparoscopic sleeve gastrectomy for weight loss. The investigators will compare patients under a standardised perioperative care program to patients who undergo routine perioperative in our hospital and determine whether patients who had optimised perioperative care went home earlier and had fewer complications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
106
Intraoperative: 1. Pre-op carbohydrate loading 2. No pre-op GIK while NBM 3. Pre-medication 4. Dexamethasone 4mg as antiemetic, IV Paracetamol (first dose) Parecoxib 40mg 5. Ondansetron regularly for first 48 hours and Cyclizine, Droperidol or Scopaderm as rescue antiemetics 6. Fluid restriction 7. Standardised method of anaesthesia 8. Give 40ml 0.5% bupivacaine with adrenaline administered prior to placement of laparoscopic port sites 9. 10ml 0.75% ropivacaine diluted to 50ml with 0.9% normal saline solution administered to surgical site prior to procedure Postoperative: 1. Rescue PCA for up to 12 hours. Oxynorm 5mg for rescue pain. Oxycontin 20mg bd/prn postoperatively 2. Maintenance IV fluids (60ml/hr plasmalyte to be stopped 0800 day 1 post op). Clear oral fluids 2 hours post op. Bariatric free oral fluids morning of day 1 3. Post operative oxygenation 4. Incentive spirometry 5. Drains (e.g. IDC) removed in recovery 6. Full mobilisation 4-8 hours post op) 7. Early Follow up
Manukau Surgery Centre
Auckland, New Zealand
Length of Hospital Stay
The trial intends to investigate whether median length of hospital stay for patients under a standardised optimised perioperative care program is less than patients who have routine perioperative care that undergo the same operation.
Time frame: day of discharge
Complications
The study will investigate complication rate for each group identifying incidence, type and severity of complication according to the Clavien Dindo Classification system
Time frame: 30 days
Readmission rates
The number of patients per group who represent to hospital for any reason during a 30 day period after the day of surgery
Time frame: 30 days
Postoperative fatigue
A measure functional recovery after surgery as measured by the validated surgical recovery scale.
Time frame: Baseline and postoperative days 1, 7 and 14
Compliance to the ERAS protocol
Prospectively recording whether components of the ERAS programme are being carried out as per protocol.
Time frame: through to day 1 postoperatively
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.