Postoperative Analgesia in Morbid Obesity

Alvarez, Adrián; Singh, Preet Mohinder; Sinha, Ashish

doi:10.1007/s11695-014-1185-2

Cited by 66 publications

(44 citation statements)

References 64 publications

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“…15 However, it is imperative to balance the risk of opioid-induced adverse events with adequate analgesia to ensure that patients do not experience complications such as atelectasis and subsequent pneumonia due to pain. 1 The current study demonstrated that patients across the BMI spectrum experience similar levels of postoperative pain and consume similar amounts of narcotic analgesics during their postoperative inpatient stay. A similar result has been demonstrated by Armaghani et al, who determined that BMI was not a risk factor for increased opioid demand in the postanesthesia care unit (PACU) in patients who had undergone elective spinal surgery.…”

Section: Discussionmentioning

confidence: 58%

“…This concern is magnified in obese patients, who typically have increased comorbidities and a higher risk of obstructive sleep apnea. 1,15,18 Thus, these patients often require close monitoring of analgesic intake postoperatively to avoid opioid-induced respiratory depression and other opioid-related adverse events. 15 However, it is imperative to balance the risk of opioid-induced adverse events with adequate analgesia to ensure that patients do not experience complications such as atelectasis and subsequent pneumonia due to pain.…”

Section: Discussionmentioning

confidence: 99%

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Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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show abstract

“…Obese patients show extreme sensitivity to even small doses of opioids [17]. Clinically significant respiratory depression increases proportionately with BMI and severity of OSA [71]. Worsening of OSA [72], postoperative respiratory obstruction [73], acute hypoxemia/hypercarbia, [74] delayed recovery [75], delayed discharge [76], increased postoperative nausea vomiting [77], and increased ICU admission rates [19] are among the few complications that have been directly attributed to perioperative opioid use in obese patients.…”

Section: Is There An Ideal Analgesic Regimen? Transfer From Pacu To Fmentioning

confidence: 99%

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

Singh

2015

OBES SURG

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Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.

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“…1,2 Given this background, multimodal analgesia is advocated for bariatric surgery with the aim of reducing opioid use. 3,4 At the time of writing, no studies were able to demonstrate a technique that can consistently remove the need for any postoperative opioid analgesia. In this study, we report the use of an anaesthesia protocol that allowed a significant proportion of our patients undergoing laparoscopic sleeve gastrectomy to be completely free from any long-acting potent opioids in the intra-operative and postoperative period.…”

Section: Introductionmentioning

confidence: 99%

Multimodal analgesia model to achieve low postoperative opioid requirement following bariatric surgery

Lam¹,

Mui²

2016

Hong Kong Med J

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Postoperative Analgesia in Morbid Obesity

Cited by 66 publications

References 64 publications

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

Multimodal analgesia model to achieve low postoperative opioid requirement following bariatric surgery

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