Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34179
Title: The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study.
Austin Authors: Weinberg, Laurence ;Scurrah, Nick ;Neal-Williams, Tom;Zhang, Wendell;Chen, Sharon;Slifirski, Hugh;Liu, David Shi Hao ;Armellini, Angelica;Aly, Ahmad ;Clough, Anthony;Lee, Dong-Kyu
Affiliation: Intensive Care
Anaesthesia
General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Heidelberg, Australia.;Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia.
Surgery (University of Melbourne)
Department of Surgery, Box Hill Hospital, Box Hill, Australia.;Melbourne Centre for Bariatric Surgery, Melbourne, Australia.
Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Issue Date: 4-Nov-2023
Date: 2023
Publication information: BMC Surgery 2023-11-04; 23(1)
Abstract: Antiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects. A retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications' administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated. One hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310). Preoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption. Australian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34179
DOI: 10.1186/s12893-023-02246-6
ORCID: 
Journal: BMC Surgery
Start page: 335
PubMed URL: 37924061
ISSN: 1471-2482
Type: Journal Article
Subjects: Diabetes
Fast-track anesthesia
Obesity
Premedication bariatric
Sleeve gastrectomy
Obesity, Morbid/surgery
Diabetes Mellitus, Type 2/surgery
Appears in Collections:Journal articles

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