Analgesic response to morphine in obese and morbidly obese patients in the emergency department

Patanwala, Asad E.; Holmes, Kimberly; Erstad, Brian L.

doi:10.1136/emermed-2012-202168

Cited by 22 publications

(8 citation statements)

References 12 publications

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“…However, in studies suggesting a size descriptor for dosing opioids, recommendations were for IBW, lean body mass, or adjusted body weight as a preferred descriptor. While no prospective studies are available that compare weight-based dosing of opioids in obese and normal weight critically ill patients, prospective and retrospective studies performed in the emergency department and postoperative setting have consistently found large variations in opioid requirements and pain control in overweight and obese patients that had no relationship to ABW [13][14][15][16]. Similarly, pharmacokinetic studies evaluating various opioids in the perioperative setting have found opioid doses based on ABW are likely to be excessive as evidenced by pharmacokinetic parameters and measured opioid concentrations [17][18][19][20][21][22].…”

Section: Analgesia Opioidsmentioning

confidence: 99%

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Erstad

Barletta

2020

Crit Care

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Practice guidelines provide clear evidence-based recommendations for the use of drug therapy to manage pain, agitation, and delirium associated with critical illness. Dosing recommendations however are often based on strategies used in patients with normal body habitus. Recommendations specific to critically ill patients with extreme obesity are lacking. Nonetheless, clinicians must craft dosing regimens for this population. This paper is intended to help clinicians design initial dosing regimens for medications commonly used in the management of pain, agitation, and delirium in critically ill patients with extreme obesity. A detailed literature search was conducted with an emphasis on obesity, pharmacokinetics, and dosing. Relevant manuscripts were reviewed and strategies for dosing are provided.

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Section: Analgesia Opioidsmentioning

confidence: 99%

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Erstad

Barletta

2020

Crit Care

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“…However, BMI did not influence the positive analgesic response to a 4-mg fixed dose of morphine administered to morbidly obese, obese, overweight, and normal-weight individuals in the emergency department setting. 182 Similarly, frovatriptan, in contrast to other triptans, retained a sustained antimigraine effect on obese subjects, possibly because of its longer half-life. 183 Chronic pain pharmacotherapy should address the concerns of obese patients about iatrogenic weight gain associated with some commonly used pain medications, such as gabapentin or pregabalin.…”

Section: Pharmacotherapy For Pain In Obese Patientsmentioning

confidence: 99%

Obesity and Chronic Pain

Narouze

Souzdalnitski

2015

Regional Anesthesia and Pain Medicine

115

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The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. Good evidence shows that weight reduction can alleviate pain and diminish pain-related functional impairment. However, inadequate pain control can be a barrier to effective lifestyle modification and rehabilitation. This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.

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“…It has been argued that clearance of fentanyl is affected by obesity, is significantly higher in obese patients and that fentanyl dosing should be based on LBW, as administration according to total body weight may lead to an overdose in the obese (30). On the other hand, oral morphine seems not to be affected by obesity (46). As fentanyl is lipophilic, obesity should affect its pharmacokinetic profiles, while a high amount of adipose tissue could result in a prolonged beta half life.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Opioid Treatment in Cancer Patients

et al. 2018

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Analgesic response to morphine in obese and morbidly obese patients in the emergency department

Abstract: Obesity status did not influence analgesic response to a fixed dose of morphine. This suggests that obese and morbidly obese patients do not require a higher dose of morphine for acute pain reduction compared to non-obese patients.

Cited by 22 publications

References 12 publications

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Drug dosing in the critically ill obese patient—a focus on sedation, analgesia, and delirium

Obesity and Chronic Pain

Factors Affecting Opioid Treatment in Cancer Patients

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