title: Acute pain management in morbid obesity - an evidence based clinical update.
abstract: Increasing numbers of patients with morbid obesity are presenting for surgery and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacological modalities in morbid obesity. For each modality the highest level of evidence was ascertained and recommendations for each pharmacological modality are presented. Though overall evidence is limited to few well conducted clinical trials, mostly related to weight loss surgery, multimodal analgesia with step-wise, severity-based, opioid-sparing approach appears to improve acute pain management in morbid obesity. The perioperative use of non-opioid adjuvants appears to offer further improvements in patient safety and outcomes. Further research into standardization of pain assessments and implementation of acute pain management protocols is required.
authors: Univerity of Ottawa, Ottawa, ON, Canada.
authors: Adele Sandra
authors: AS
authors: Budiansky
authors: St Richard's Hospital, Chichester, UK.
authors: Michael P
authors: MP
authors: Margarson
authors: The Ottawa Hospital, University of Ottawa, ON, Canada. Electronic address: neipe@toh.ca.
authors: Naveen
authors: N
authors: Eipe
mesh_terms: D059787:Acute Pain / Q000517:prevention & control*; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000700:Analgesics
keywords: Acute Hyperalgesia; Acute Pain Management; Morbid Obesity; Multimodal Analgesia; Non- opioid adjuvants