Influence of preoperative psychotropic medications on opioid requirements and outcomes following bariatric surgery

Sheldon, Rowan R.; Holtestaul, Torbjorg; Morte, Douglas; Jones, Ian; Forte, Dominic M.; Bingham, Jason

doi:10.1016/j.amjsurg.2020.03.019

Cited by 2 publications

(1 citation statement)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both new and prolonged opioid use are important complications of bariatric surgical procedures [ 17 ]. Patients with obesity using prescription opioids preoperatively are more likely to continue these drugs after bariatric surgery than opioid-naïve patients, which is not without risks [ 18 , 19 , 20 , 21 , 22 ]. The perioperative use of opioids in bariatric surgery results in worsened clinical outcomes (e.g., a more extended hospital stay and increased episodes of apnea) and in particular persistent opioid use post-discharge [ 17 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Opioid Analgesics after Bariatric Surgery: A Scoping Review to Evaluate Physiological Risk Factors for Opioid-Related Harm

Wuyts

Torensma

Schellekens

et al. 2023

JCM

View full text Add to dashboard Cite

The persisting use of opioids following bariatric surgery has emerged as a prevalent complication, heightening the probability of opioid-related harm (ORM), such as opioid-related fatalities and prescription opioid use disorder (OUD). A comprehensive review of PubMed literature from 1990 to 2023 was conducted to pinpoint physiological influences on postoperative ORM. As a result, we found that patients undertaking bariatric operations often exhibit an inherently higher risk for substance use disorders, likely attributable to genetic predisposition and related neurobiological changes that engender obesity and addiction-like tendencies. Furthermore, chronic pain is a common post-bariatric surgery complaint, and the surgical type impacts opioid needs, with increased long-term opioid use after surgeries. Additionally, the subjective nature of pain perception in patients with obesity can distort pain reporting and the corresponding opioid prescription both before and after surgery. Furthermore, the postoperative alterations to the gastrointestinal structure can affect the microbiome and opioid absorption rates, resulting in fluctuating systemic exposure to orally ingested opioids. The prospect of ORM development post-bariatric surgery appears amplified due to a preexisting susceptibility to addictive habits, surgically induced pain, modified gut–brain interaction and pain management and the changed pharmacokinetics post-surgery. Further research is warranted to clarify these potential risk variables for ORM, specifically OUD, in the bariatric population.

show abstract