A multimodal pain management therapy that includes the non-opioid local analgesic Exparel lessens the need for post-op narcotics after bariatric surgery, according to a recent study.

For the study, Andras Sandor, MD, FACS, FASMBS, and colleagues at the Hallmark Health Center for Weight Management and Weight Loss Surgery in Medford, Mass., observed the pain management regimens of 90 patients undergoing laparoscopic bariatric procedures.

Half of the patients received a multimodal approach to post-op pain management, including Pacira Pharmaceutical's bupivacaine liposome injectable suspension drug, Exparel, infiltrated into the transversus abdominis plane (a process known as iTAP). The other half were given ketorolac and a lidocaine and bupivacaine/epinephrine combination perioperatively, and pain pumps of hydromorphone afterward.

Each group was allowed opioids at 2 days post-op. But the multimodal group consumed 60.7% fewer opioids. Additionally, they exhibited a greater return of bowel function at the 2-day mark. Dr. Sandor and his team presented their findings at the American Society for Metabolic & Bariatric Surgery's 2013 Obesity Week in November.

"The risks of opioids are pronounced in the bariatric population; utilizing a non-opioid platform with Exparel iTAP at its foundation contributed to decreasing both the amount of opioids needed and their resultant opioid-related adverse effects," says Dr. Sandor.

David Bernard