Patient controllediv analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia

Abstract

P Pu ur rp po os se e: : To examine the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. We retrospectively compared the postoperative periods in all patients undergoing this procedure in our institution between November 1999 and November 2001.M Me et th ho od ds s: : According to their perioperative pain treatment, patients were assigned to a PCA group (with iv morphine) or an epidural analgesia group, in which patients received either intermittent doses of morphine or continuous infusions of bupivacaine/fentanyl. Study endpoints included quality of pain control, incidence of cardiovascular and respiratory complications, analgesia related side effects, time to ambulation and first flatus, length of hospital stay, and wound infections. R Re es su ul lt ts s: : Data from 86 patients were analyzed with 40 patients in the PCA group and 46 patients in the epidural group. Groups were similar with respect to age, body mass index, and gender. The type of analgesia did not affect the quality of pain control at rest, the frequency of nausea and pruritus, the time to ambulation and return of gastrointestinal function, and the length of hospital stay. Patients receiving epidural analgesia had a greater risk of wound infection than subjects with PCA (epidural group: 39%, PCA group: 15%, P = 0.01).

Anesthésie-réanimation chez l’obèse

“…En cas de recours à la morphine, l'auto-administration par voie IV est pré-conisée car chez l'obèse, l'injection intramusculaire est associée à des résorptions médicamenteuses imprévisibles. Récemment, l'analgésie autocontrolée (ACP) avec de la morphine IV s'est révélée comme une stratégie d'analgésie acceptable lorsqu'on la compare à l'analgésie péridurale chez des obèses morbides opérés d'un bypass gastrique [49]. L'analgésie péridurale est une alternative à l'ACP mais nécessite une certaine expérience.…”

Opioids and opiates: analgesia with cardiovascular, haemodynamic and immune implications in critical illness

“…Furthermore, whilst function may appear to be preserved or only moderately affected by the administration of opioids, the stress, inflammatory and metabolic response to the injury produced by surgery, trauma or infection may unmask the underlying mechanisms that are affected by the presence of opioids in this patient population. Though this has not been adequately explored, some differences in the route of opioid administration have been observed in association with infection incidence, with a greater risk of wound infection in patients receiving epidural opioid analgesia than in those receiving intravenous opioid delivery [118]. A careful analysis of the impact of opiate analgesia on the incidence of infectious complications following traumatic injury, surgery or in critically ill patients warrants further study.…”

Anesthesia in the obese

“…When narcotics are needed, IV patient-controlled anesthesia (PCA) is recommended because absorption after intramuscular injection is unpredictable in the obese patient. A recent study showed that IV morphine by PCA was superior to epidural analgesia in obese patients after gastric bypass [49]. Epidural analgesia is an alternative to PCA but the technique requires more experience.…”