Abstract
Background
Postoperative analgesia following bariatric surgery is complicated by the high prevalence of obstructive sleep apnea which is worsened by systemic opioids. The primary aim of this study is to identify patient factors associated with greater postoperative opioid use in patients undergoing laparoscopic bariatric surgery.
Methods
A retrospective chart review of 384 consecutive patients who underwent laparoscopic bariatric surgery from January 2000 to December 2006 was performed. Patient characteristics including demographic and socioeconomic variables, tobacco, or psychotropic medications (i.e., antidepressants) use at the time of surgery, and previous psychiatric hospitalization were analyzed to determine potential associations with regards to opioid requirements and the occurrence of severe pain (>7 on a 0–10 numeric pain scale) during the first 48 h postoperatively. For comparison, all postoperative opioids were converted to oral morphine equivalents.
Results
Opioid requirements were higher among younger (P < 0.001), male (P = 0.019), unmarried patients (P = 0.034), and patients with previous psychiatric hospitalizations (P < 0.001). Current tobacco users trended to require more opioids (P = 0.054). Adjusted analysis found that age, gender, and previous psychiatric hospitalization were independently associated with greater opioid requirements. The occurrence of severe pain was common (in 42% of patients) but it was not associated with any variables measured in this study except for its increased presence among better-educated patients (P = 0.021).
Conclusions
In patients undergoing laparoscopic bariatric surgery, those who are younger, male, and who have been previously hospitalized for psychiatric disorders use more opioids in the first 48 h postoperatively.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
El Shobary H, Christou N, Backman S, et al. Effect of laparoscopic versus open gastric bypass surgery on postoperative pain and bowel function. Obes Surg. 2006;16:437–42.
Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83.
Catley DM, Thornton C, Jordan C, et al. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology. 1985;63:20–8.
Macintyre PE, Jarvis DA. Age is the best predictor of postoperative morphine requirements. Pain. 1996;64:357–64.
Joels CS, Mostafa G, Matthews BD, et al. Factors affecting intravenous analgesic requirements after colectomy. J Am Coll Surg. 2003;197:780–5.
Warner DO, Patten CA, Ames SC, et al. Smoking behavior and perceived stress in cigarette smokers undergoing elective surgery. Anesthesiology. 2004;100:1125–37.
Creekmore FM, Lugo RA, Weiland KJ. Postoperative opiate analgesia requirements of smokers and nonsmokers. Ann Pharmacother. 2004;38:949–53.
De Cosmo GMD, Congedo EMD, Lai CP, et al. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain. 2008;24:399–405.
Katz J, Poleshuck EL, Andrus CH, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain. 2005;119:16–25.
Principles of analgesic use in the treatment of acute pain and cancer pain. Skokie, IL, USA: American Pain Society, 1999.
Serlin RC, Mendoza TR, Nakamura Y, et al. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain. 1995;61:277–84.
Mühlhans B, Horbach T, de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample. Gen Hosp Psychiatry; 31: 414-21.
Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry. 2007;164:328–34.
Girdler SS, Maixner W, Naftel HA, et al. Cigarette smoking, stress-induced analgesia and pain perception in men and women. Pain. 2005;114:372–85.
Flood P, Daniel D. Intranasal nicotine for postoperative pain treatment. Anesthesiology. 2004;101:1417–21.
Turan A, White PF, Koyuncu O, et al. Transdermal nicotine patch failed to improve postoperative pain management. Anesth Analg. 2008;107:1011–7.
Weingarten TN, Iverson BC, Shi Y et al. Impact of tobacco use on the symptoms of painful temporomandibular joint disorders. Pain 2009 (in press)
Weingarten TN, Podduturu VR, Hooten WM, et al. Impact of tobacco use in patients presenting to a Multidisciplinary Outpatient Treatment Program for fibromyalgia. Clin J Pain. 2009;25:39–43.
Center for Disease Control. Cigarette smoking among adults—United States, 2007. Morbidity and Mortality Weekly Report 2008:1221-1226.
Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17:52–64.
Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: a prospective study. Clin J Pain. 2005;21:439–45.
Financial support
Support was provided solely from institutional and departmental sources (Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA).
There are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weingarten, T.N., Sprung, J., Flores, A. et al. Opioid Requirements after Laparoscopic Bariatric Surgery. OBES SURG 21, 1407–1412 (2011). https://doi.org/10.1007/s11695-010-0217-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-010-0217-9