REVIEW ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 339-346

Perioperative Pain Management in Bariatric Anesthesia


Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

Correspondence Address:
Naveen Eipe
Staff Anesthesiologist and Clinical Lead for Bariatric Anesthesia, The Ottawa Hospital, Associate Professor, Department of Anesthesiology & Pain Medicine, University of Ottawa, 1053 Carling Avenue, B310, Civic Campus, The Ottawa Hospital, Ottawa, ON, K1Y4E9
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_236_22

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Weight loss (bariatric) surgery is the most commonly performed elective surgical procedure in patients with morbid obesity. In this review, we provide an evidence-based update on perioperative pain management in bariatric anesthesia. We mention some newer preoperative aspects—medical optimization, physical preparation, patient education, and psychosocial factors—that can all improve pain management. In the intraoperative period, with bariatric surgery being almost universally performed laparoscopically, we emphasize the use of non-opioid adjuvant infusions (ketamine, lidocaine, and dexmedetomidine) and suggest some novel regional anesthesia techniques to reduce pain, opioid requirements, and side effects. We discuss some postoperative strategies that additionally focus on patient safety and identify patients at risk of persistent pain and opioid use after bariatric surgery. This review suggests that the use of a structured, step-wise, severity-based, opioid-sparing multimodal analgesic protocol within an enhanced recovery after surgery (ERAS) framework can improve postoperative pain management. Overall, by incorporating all these aspects throughout the perioperative journey ensures improved patient safety and outcomes from pain management in bariatric anesthesia.


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