Challenges in the Optimisation of Post-operative Pain Management with Opioids in Obese Patients: a Literature Review

• Published in: Obesity surgery Vol. 23; no. 9; pp. 1458 - 1475
• Main Authors: Lloret-Linares, C., Lopes, A., Declèves, X., Serrie, A., Mouly, S., Bergmann, J.-F., Perrot, S.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-09-2013; Springer Nature B.V
• Subjects: Analgesics, Opioid - therapeutic use; Bariatric Surgery - adverse effects; Body Mass Index; Drug Administration Schedule; Female; France; Gastrointestinal surgery; Humans; Male; Medicine; Medicine & Public Health; Narcotics; Obesity; Obesity, Morbid - genetics; Obesity, Morbid - surgery; Pain management; Pain Measurement; Pain, Postoperative - drug therapy; Pain, Postoperative - genetics; Polymorphism, Single Nucleotide; Postoperative period; Receptors, Opioid, mu - drug effects; Receptors, Opioid, mu - genetics; Review; Surgery; France; Obesity; Analgesia; Morphine; Post-operative pain; Surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-013-0998-8

An increasing number of obese patients are undergoing surgery, particularly bariatric and orthopaedic surgery. The physiological differences between obese and normal-weight subjects may modify not only anaesthetic requirements during surgery but also post-operative analgesic management, raising a number of challenges in a critical period. In this review, we analyse studies of post-operative pain management with opioids in obese subjects. We discuss the genetic factors common to pain and obesity and the factors potentially modifying opioid pharmacokinetics and pharmacodynamics in obese patients, and we analyse the overall efficacy and safety of opioids for pain management during the post-operative period in obese patients. Both modifications to surgical methods and additional analgesic treatments to decrease the requirement for opioids may improve early rehabilitation and quality of care and reduce adverse effects in obese patients.