Postoperative Analgesia in Morbid Obesity

• Published in: Obesity surgery Vol. 24; no. 4; pp. 652 - 659
• Main Authors: Alvarez, Adrian, Singh, Preet Mohinder, Sinha, Ashish C.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2014; Springer Nature B.V
• Subjects: Analgesia - methods; Analgesics; Analgesics - therapeutic use; Analgesics, Opioid - therapeutic use; Humans; Laparoscopy; Medicine; Medicine & Public Health; Narcotics; Nerve Block - methods; Obesity; Obesity, Morbid - complications; Pain management; Pain, Postoperative - therapy; Patient safety; Postoperative period; Review Article; Sleep Apnea, Obstructive - complications; Surgery; Opioid sparing analgesia; Morbid obese postoperative analgesia; Adjuvant analgesics for morbid obese
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-014-1185-2

Morbidly obese patients due to high incidence of obstructive sleep apnea (OSA) are predisposed to opioid induced airway obstruction and thus frontline high ceiling analgesics (opioids) have concerns based on safety in their liberal use. Although surgical techniques over the last two decades have seen a paradigm shift from open to laparoscopic procedures for morbidly obese patients; optimally titrated yet safe analgesic management still remains a challenge. The present review sums up the analgesic options available for management of morbidly obese patients undergoing surgery. We highlight the utility of multimodal approach for analgesia with combinations of agents to decrease opioids requirements. Pre-emptive analgesia may be additionally used to improve the efficacy of postoperative pain relief while allowing further reductions in opioid requirements.