title: Challenges in the optimisation of post-operative pain management with opioids in obese patients: a literature review.
abstract: 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.
authors.affiliation: INSERM U705, CNRS UMR 8206, Neuropsychopharmacology of Drug Addiction, Faculty of Pharmacy, University Paris Descartes, Paris 75006, France. celialloret@yahoo.fr
authors.forename: C
authors.initials: C
authors.lastname: Lloret-Linares
authors.forename: A
authors.initials: A
authors.lastname: Lopes
authors.forename: X
authors.initials: X
authors.lastname: Declèves
authors.forename: A
authors.initials: A
authors.lastname: Serrie
authors.forename: S
authors.initials: S
authors.lastname: Mouly
authors.forename: J-F
authors.initials: JF
authors.lastname: Bergmann
authors.forename: S
authors.initials: S
authors.lastname: Perrot
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects; D015992:Body Mass Index; D004334:Drug Administration Schedule; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000235:genetics / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000235:genetics; D020641:Polymorphism, Single Nucleotide; D017450:Receptors, Opioid, mu / Q000187:drug effects* / Q000235:genetics
chemical_list: D000701:Analgesics, Opioid; C485764:OPRM1 protein, human; D017450:Receptors, Opioid, mu