[Regional anaesthesia in obese patient].
OBJECTIVE
To detail specificity of regional anaesthesia techniques in the obese patient.


METHODS
Articles were selected from Medline database using the combination of the following keywords: obesity, peripheral nerve block, spinal anaesthesia, epidural, morbidity, mortality.


METHODS
Most recent original articles or review have mainly been selected. Some case reports that highlighted specific points were added.


METHODS
Articles were analyzed for advantages and drawbacks, and risks of different techniques in obese patient.


RESULTS
Techniques avoiding obese patient's mobilization are recommended. The use of skin landmarks may be challenging for both central and peripheral blocks. Ultrasound techniques should improve block performance, even though deep fat layers seem limit sound diffusion. Success rate and incidence of complications are usually increased after regional anaesthesia technique in obese patient. The reduction of intrathecal local anesthetic dose remains controversial in this population.


CONCLUSIONS
Regional anaesthesia techniques could represent an alternative to general anaesthesia (less cardiorespiratory complications). However, many specific considerations have to be taken into account.
Pôle d'anesthésie et réanimation, service orthopédie, CHU Purpan, place Dr-Baylac, TSA40031, 31059 Toulouse cedex 9, France. fuzier.r@gmail.com
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Fuzier
D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000379:methods*; D000767:Anesthesia, Epidural; D000768:Anesthesia, General / Q000009:adverse effects; D000775:Anesthesia, Spinal; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D009407:Nerve Block; D009765:Obesity / Q000150:complications* / Q000401:mortality; D012306:Risk; D013514:Surgical Procedures, Operative / Q000401:mortality; D014463:Ultrasonography
D000777:Anesthetics; D000779:Anesthetics, Local