Postoperative analgesia in a morbidly obese patient with chronic renal failure.
BACKGROUND
The number of surgical interventions performed in obese patients has recently been increasing. Anaesthesia in a morbidly obese patient may be difficult, due to many pathophysiologic changes and co-morbidities, together with altered pharmacokinetics and pharmacodynamics of anaesthestic agents. We present a case of multimodal preventive analgesia in a bariatric patient with chronic renal failure.


METHODS
A 36-year-old, morbidly obese man (BMI 47.8 kg m-2) was scheduled for a laparoscopic adjustable gastric banding (LAGB). The anaesthetic risk was increased because of hypertension, chronic renal failure, steatohepatitis and obstructive sleep apnoea syndrome. 30 minutes before anaesthesia, the patient received 2 g iv paracetamol. After induction, he was given 8 mg dexamethasone and 100 mg tramadol. All port-sites were infiltrated with 0.5% bupivacaine and adrenaline, both before skin incision, and before wound closure. Since NSAIDs and opioids were contraindicated because of the patient's co-morbidities, postoperative analgesia consisted of tramadol and paracetamol, given alternately, every 3 hours. The patient was discharged home 28 hours after surgery.


CONCLUSIONS
According to the Polish Postoperative Pain Management Recommendations 2008, the pain after LAGB is multifactorial and rated as category 2. The pre-emptive analgesia and postoperative regimen presented in this case can be recommended in similar cases.
Hospital of Minimally-Invasive and Reconstructive Surgery in Bielsko-Biała, Poland. andrzej.daszkiewicz@mp.pl
Andrzej
A
Daszkiewicz
Mariusz
M
Wyleżoł
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D050110:Bariatric Surgery; D015992:Body Mass Index; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives; D007676:Kidney Failure, Chronic / Q000150:complications*; D010535:Laparoscopy; D008297:Male; D008874:Midazolam; D009767:Obesity, Morbid / Q000150:complications*; D017294:Ondansetron / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011229:Preanesthetic Medication; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics; D006993:Hypnotics and Sedatives; D000082:Acetaminophen; D017294:Ondansetron; D008874:Midazolam; D005283:Fentanyl; D002045:Bupivacaine