Acute postoperative pain and opioid consumption after laparoscopic cholecystectomy is associated with body mass index: a retrospective observational single-center study

Yıl 2022, , 1 - 6, 17.01.2022

Ökkeş Hakan Miniksar , Mehmet Kağan Katar

https://doi.org/10.32322/jhsm.996147

Cited By: 2

Öz

Aim: The aim of this study was to determine the relationship between postoperative pain scores and opioid analgesic consumption according to BMI levels in patients undergoing laparoscopic cholecystectomy.
Material and Method: In this retrospective observational study, we scanned the medical data of 154 patients aged from 18-55 years who underwent laparoscopic cholecystectomy. Patients were divided into two groups based on the BMI cut-off value (Group Non-obese, BMI <30 kg/m2, n=59; Group Obese, BMI >30 kg/m2, n=35). Postoperative visual analog scale (VAS) pain scores, total tramadol consumption, and intraoperative fentanyl bolus requirements were compared between the groups at five-time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour, T3: 12th hour, and T4: 24th hour).
Results: Postoperative VAS pain scores were significantly higher in the Group Obese at T1-2 time points (p=0.009). The number of patients with a VAS score of >3 at the T-0 time point was significantly higher in the Group Obese (p=0.014). Total tramadol consumption was significantly higher in the Group Obese (40.0±46.6 mg) than in the Group Non-obese (16.10±34.0 mg) (p=0.003). There was a weak positive correlation between BMI and postoperative pain scores (T0, T-1, T-2) of the patients, and a moderate positive correlation (r=0.307) between total tramadol consumption.
Conclusions: According to the results of this study, BMI is associated with acute postoperative pain in patients undergoing cholecystectomy, and obese patients require more opioid analgesia postoperatively. However, postoperative analgesia requirements should be determined according to BMI levels in patients undergoing cholecystectomy.

Anahtar Kelimeler

Obesity, postoperative pain, analgesia, opioid consumption, laparoscopy

Kaynakça

• Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg 2000; 87: 273-84.
• Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001; 90: 261-9.
• Karanikolas M, Swarm RA. Current trends in perioperative pain management. Anesthesiol Clin North Am 2000; 18: 575-99.
• Liu Q, Ji MH, Dai YC, et al. Predictors of acute postsurgical pain following gastrointestinal aurgery: a prospective cohort study. Pain Res Manag 2021; 2021:6668152
• Wright LJ, Schur E, Noonan C, Ahumada S, Buchwald D, Afari N. Chronic pain, overweight, and obesity: findings from a community-based twin registry. J Pain 2010; 11: 628–35.
• Yang MMH, Hartley RL, Leung AA, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open 2019; 9: e025091.
• Grodofsky SR, Sinha AC. The association of gender and body mass index with postoperative pain scores when undergoing ankle fracture surgery. J Anaesthesiol Clin Pharmacol 2014; 30: 248–52.
• Vergés MTS, Puigbò EC, Cortada MG, Rizo MR, Garcia MVM. New trends in the treatment of post-operative pain in general and gastrointestinal surgery. Cir Esp 2009; 86: 63-71.
• Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009; 111: 657–77.
• Elgendy H, Youssef T, Banjar A, Elmorsy S. Decreased analgesic requirements in super morbidly versus morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg 2020; 30: 2715–22.
• Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997; 85: 808–16.
• González-Callejas C, Aparicio VA, De Teresa C, Nestares T. Association of body mass index and serum markers of tissue damage with postoperative pain. the role of lactate dehydrogenase for postoperative pain prediction. Pain Med 2020; 21: 1636–43.
• Chin SH, Huang WL, Akter S, Binks M. Obesity and pain: a systematic review. Int J Obes 2020; 44: 969–79.
• Zahorska-Markiewicz B, Kucio C, Pyszkowska J. Obesity and pain. Hum Nutr Clin Nutr 1983; 37: 307–10.
• Janke EA, Collins A, Kozak AT. Overview of the relationship between pain and obesity: what do we know? where do we go next? J Rehabil Res Develop 2007; 44: 245-62.
• Hitt HC, McMillen RC, Thornton-Neaves T, Koch K, Cosby AG. Comorbidity of obesity and pain in a general population: results from the southern pain prevalence study. J Pain 2007; 8: 430–6.
• Khawaja XZ, Chattopadhyay AK, Green IC. Increased β-endorphin and dynorphin concentrations in discrete hypothalamic regions of genetically obese mice. Brain Res 1991; 555: 164–8.
• Schug SA, Raymann A. Postoperative pain management of the obese patient. Best Pract Res Clin Anaesthesiol 2011; 25: 73–81.
• Watcha MF, White FP. Postoperative nause and womiting. Anesthesiology 1992; 77: 162-84.
• Kranke P, Apfel CC, Papenfuss T, et al. An increased body mass index is no risk factor for postoperative nausea and vomiting. a systematic review and results of original data. Acta Anaesthesiol Scand 2001; 45: 160–6.