Background

Patient Controlled Analgesia (PCA) pumps are frequently used after surgery to offer an individualized on-demand effective method of pain control rather than periodic intravenous (IV) narcotics. Research suggests this type of pain control has been found to result in less pain and earlier discharge from the hospital in most patient populations. Systemic opioids and anesthesia medications have a known side effect of nausea and vomiting. Weight Loss Surgery patients additionally experience nausea and vomiting post procedure due to alterations in the gastrointestinal tract and gut hormones. The most common reason for delayed discharge is poor fluid intake due to nausea and vomiting. The purpose of this study was two-fold in discovering if the elimination of the PCA would reduce the overall length of stay (LOS) and reduce the incidences of nausea and vomiting associated with opioid use.

Methods

Two hospitals stopped the use of PCAs to test this hypothesis. Hospital #1 is a 73 bed community based facility. Hospital #2 is a 467 bed trauma facility. Both hospitals additionally tracked the use of Phenergan given as needed for nausea and vomiting. All patient received around the clock Zofran and wore a scopolamine transdermal patch as part of the standard order set that had been in practice since January 2015. Hospital # 1 eliminated the use of the PCA completely and used Norco by mouth as needed with IV Dilaudid if needed after pain not controlled with Norco. Hospital #1 pre-trial N=65 and post-trial N=92. Hospital number 2 discontinued the use of the PCA at midnight on the day of surgery and uses IV Tylenol for 24 hours post-op as well as Norco. Hospital #2 pre-trial N=35 and post-trial N=65. The length of stay was tracked for five months prior to eliminating the use of the PCA and five months after. The types of weight loss surgery procedures included gastric bypass, vertical sleeve gastrectomy and the standard duodenal switch. All patients during the eight month period were included in the study except for revisions and emergencies.

Results

The LOS for both facilities reduced by 0.2. Phenergan usage results were too variable to correlate results. Phenergan was frequently used immediately post-operatively on day of surgery resulting in a timeframe that would not impact the overall LOS.

Conclusions

Eliminating the use of PCA after Weight Loss Surgery reduces the overall LOS.