Skip to main content
SpringerLink
Log in

Is Postoperative Opioid Analgesia Safe for Obese Patients?

  • Chapter
  • First Online:
Controversies in the Anesthetic Management of the Obese Surgical Patient

  • 831 Accesses

Abstract

Opioids are the drugs of choice for strong postoperative pain treatment in non obese patients and age is the best predictor for daily dose consumption; respiratory depression is unusual but a possible side effect. In case of MO (morbidity obese) patients some special considerations are useful for their application; first, age it is not considered a reliable factor for morphine consumption, and for individualized opioids a dosage multi-pharmological approach and intravenous PCA administration avoiding spinal infusion is recommended. In addition, close perioperative control strategies, including measures to detect and prevent postoperative hypoxemia, are necessary to increase safety and improve outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Leykin Y, Miotto L, Pellis T (2011) Pharmacokinetic considerations in the obese. Best Pract Res Clin Anaesthesiol 25:27–36

    Article  PubMed  CAS  Google Scholar 

  2. Casati A, Putzu M (2005) Anesthesia in the obese patient: pharmacokinetic considerations. J Clin Anesth 17:134–145

    Article  PubMed  CAS  Google Scholar 

  3. Bjorkman S, Wada DR, Stanski DR (1998) Application of physiologic models to predict the influence of changes in body composition and blood flows on the pharmacokinetics of fentanyl and alfentanil in patients. Anesthesiology 88:657–667

    Article  PubMed  CAS  Google Scholar 

  4. Lemmens HJ (2010) Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol 23:485–491

    Article  PubMed  Google Scholar 

  5. Macintyre PE, Jarvis DA (1996) Age is the best predictor of postoperative morphine requirements. Pain 64:357–364

    Article  PubMed  CAS  Google Scholar 

  6. Ahmad S, Nagle A, McCarthy RJ, Fitzgerald PC, Sullivan JT, Prystowsky J (2008) Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 107:138–143

    Article  PubMed  Google Scholar 

  7. Fanelli G, Berti M, Baciarello M (2008) Updating postoperative pain management: from multimodal to context-sensitive treatment. Minerva Anestesiol 74:489–500

    PubMed  CAS  Google Scholar 

  8. Charghi R, Backman S, Christou N, Rouah F, Schricker T (2003) Patient controlled i.v. analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia. Can J Anaesth 50:672–678

    Article  PubMed  Google Scholar 

  9. Levin A, Klein SL, Brolin RE, Pitchford DE (1992) Patient-controlled analgesia for morbidly obese patients: an effective modality if used correctly. Anesthesiology 76:857–858

    Article  PubMed  CAS  Google Scholar 

  10. Choi YK, Brolin RE, Wagner BK, Chou S, Etesham S, Pollak P (2000) Efficacy and safety of patient-controlled analgesia for morbidly obese patients following gastric bypass surgery. Obes Surg 10:154–159

    Article  PubMed  CAS  Google Scholar 

  11. Passannante AN, Rock P (2005) Anesthetic management of patients with obesity and sleep apnea. Anesthesiol Clin North Am 23:479–491

    Google Scholar 

  12. Patel J (1999) Anaesthesia for LSCS in a morbidly obese patient. Anaesth Intensive Care 27:216–219

    PubMed  CAS  Google Scholar 

  13. Kehlet H, Holte K (2001) Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62–72

    Article  PubMed  CAS  Google Scholar 

  14. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1493

    Article  PubMed  CAS  Google Scholar 

  15. von Ungern-Sternberg BS, Regli A, Reber A, Schneider MC (2005) Effect of obesity and thoracic epidural analgesia on perioperative spirometry. Br J Anaesth 94:121–127

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Anesthesiology, Intensive Care and Pain Therapy, University Hospital of Parma, Parma, Italy

    Fernanda Tagliaferri, Marco Berti, Raffaella Troglio & Guido Fanelli

Authors
  1. Fernanda Tagliaferri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Berti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raffaella Troglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Berti .

Editor information

Editors and Affiliations

  1. Santa Maria degli Angeli Medical Centre, Pordenone, Italy

    Yigal Leykin

  2. Stanford University School of Medicine, Stanford, 94305, California, USA

    Jay B. Brodsky

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Italia

About this chapter

Cite this chapter

Tagliaferri, F., Berti, M., Troglio, R., Fanelli, G. (2013). Is Postoperative Opioid Analgesia Safe for Obese Patients?. In: Leykin, Y., Brodsky, J. (eds) Controversies in the Anesthetic Management of the Obese Surgical Patient. Springer, Milano. https://doi.org/10.1007/978-88-470-2634-6_23

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2634-6_23

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2633-9

  • Online ISBN: 978-88-470-2634-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation