Effect of a Roux-en-Y Gastric Bypass on the Pharmacokinetics of Oral Morphine Using a Population Approach

Lloret‐Linares, Célia; Hirt, Déborah; Bardin, Christophe; Bouillot, Jean‐Luc; Oppert, Jean‐Michel; Poitou, Christine; Chast, François; Mouly, Stéphane; Scherrmann, Jean‐Michel; Bergmann, Jean‐François; Declèves, Xavier

doi:10.1007/s40262-014-0163-0

Cited by 57 publications

(50 citation statements)

References 46 publications

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“…214 The researchers found that Roux-en-Y gastric bypass and subsequent weight loss radically increased the rate of morphine absorption and also somewhat increased morphine exposure. They suggested that the dose of immediate-release forms of morphine might be divided in obese patients after bypass to prevent adverse events due to early and high morphine plasma peaks.…”

Section: Interventional Pain Management 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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Section: Interventional Pain Management In Obese Patientsmentioning

confidence: 99%

Obesity and Chronic Pain

Narouze

Souzdalnitski

2015

Regional Anesthesia and Pain Medicine

115

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“…Sixteen from 60 phase 2 studies scored over 65% and were included for further analysis (Table 1) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Pain had been measured and recorded in over 2000 subjects in randomized controlled trials (RCT, n=7) or observational studies (n=9).…”

Section: Resultsmentioning

confidence: 99%

Peri-operative pain in patients experiencing bariatric surgery

Kumar¹,

Soekarman²,

Singh³

et al. 2017

Med Clin Arch

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A review of the literature was performed to identify follow-up studies on pain and bariatric surgery (gastric band, gastric sleeve or R-en-Y gastric bypass) as intervention. The main objective of this study was to find information on the prevalence of chronic pain in patients undergoing any of the mentioned surgical techniques and the incidence of chronic postsurgical pain after bariatric surgery.16 studies were included for further analysis with over 2000 subjects. 2/3 of the information was on bypass surgery. "Short term" studies with data on pain within 3 months after surgery were randomized controlled trials (RCTs) comparing surgical techniques or analgesia. Pre-operative pain status had not been documented. However, peri-operative pain management was reported in detail. In 8 observational studies, pain data were available exceeding 3 months after surgery ("long term" studies). While pre-operative pain data were reported in the latter studies, in over half the anatomic location of the pain had not been specified. An accurate estimation of the incidence of chronic postsurgical pain after bariatric surgery was not possible based on the available data. The number of comparable studies was low and the anatomic location of the pain had not been specified. Data on pain between 1 week and 6 months after surgery are lacking. This period is important, since it contains the time point after which the measured pain can be defined as chronic.

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“…Indeed, most studies have been performed on patients with Roux-en-Y gastric Bypass (RYGB). Many have demonstrated changes in drug absorption parameters that are certainly related to the smaller gastric pouch after surgery and the achlorydric state associated, and few showed change in overall exposure [3][4][5][6]. Thus, the consequences of restrictive procedures merit the same attention as time to maximal concentration (T max ) and maximal concentration (C max ) may change and have clinical consequences for some drugs.…”

Section: Weaknesses In the Research Done In This Fieldmentioning

confidence: 99%

“…An ideal pharmacological study would include pharmacokinetic analysis before and immediately after surgery, a few months later after the patient experienced weight loss, and ideally when the weight stabilized. We conducted a pharmacokinetic study in obese patients before, immediately after (8-15 days), and six months after surgery (OBEMO study) [4]. It was very difficult to conduct the study immediately after surgery.…”

Section: Potential and Challenges Of This Area Of Researchmentioning

confidence: 99%

“…In a clinical study, we demonstrated that doses of oral morphine sulfate solution should be reduced in patients with RYGB to limit the risk of adverse events, as RYGB clearly increased the rate at which oral morphine sulfate is absorbed [4]. It is also important to know whether a standard dose is appropriate when the effect is generally evaluated over a span of 4 weeks or even months.…”

Section: Needs To Achieve the Ultimate Goal Of The Researchmentioning

confidence: 99%

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