I am asking about the most effective protocol for management of postoperative lap sleeve gastrectomy pain ?
We start with PP I with H2 blockers and paracetamol. If no effective NBA ID. If not effective narcotics are given
Assess pain in detail..type time distension asso with food ..??/etc.. is it visceral nosiceptive c afferent pain of the cut stomach or its peritoneum or Ulcerogenic pain healed by local anesthetic gels drinks liquids PPI and Drotaverine 80 mgms.tid.sos.sleep on left lateral side,eating small feeds etc. we all know.If it is obstructive peristaltic pain it will need endoscopy to gauge any narrowing ..slowly as stomach accommodates pain should go..
most effective method for the immidiate post op pain relief ,i already mentioned.pain later may be due to various reasons which needs careful assessment as it can be non surgical aswell,
Assuming it's laparoscopic procedure, it's mostly port site pain in the immediate post op period. If you are closing the port sites esp with transfascial sutures that's where the pt's complain most pain. We are managing the pain with local infiltration of Marcaine at the port site, Opoid PCA for overnight after surgery, followed by PO pain meds ( Vicodin, Oxycodone or Morphine elixir) with introduction of liquid diet next morning. On discharge they are given the same elixir for few days.
I realize you may not have any opioids for pain control, leave alone the choice.
Nausea of course is the main complaint as it is & opioids can make it worse. Some of the patients just take Tylenol elixir.
TAP stands for transversus abdominis plane block, a regional block for T6-L1 nerves in the anterior abdominal wall. Ideally performed with ultrasound guidance.
Hope it helps.
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