INSERM U705, CNRS UMR 8206, Neuropsychopharmacology of Drug Addiction, Faculty of Pharmacy, University Paris Descartes, Paris 75006, France.
Obes Surg. 2013 Sep;23(9):1458-75. doi: 10.1007/s11695-013-0998-8.
An increasing number of obese patients are undergoing surgery, particularly bariatric and orthopaedic surgery. The physiological differences between obese and normal-weight subjects may modify not only anaesthetic requirements during surgery but also post-operative analgesic management, raising a number of challenges in a critical period. In this review, we analyse studies of post-operative pain management with opioids in obese subjects. We discuss the genetic factors common to pain and obesity and the factors potentially modifying opioid pharmacokinetics and pharmacodynamics in obese patients, and we analyse the overall efficacy and safety of opioids for pain management during the post-operative period in obese patients. Both modifications to surgical methods and additional analgesic treatments to decrease the requirement for opioids may improve early rehabilitation and quality of care and reduce adverse effects in obese patients.
越来越多的肥胖患者接受手术治疗，尤其是减重和矫形手术。肥胖患者与正常体重患者的生理差异不仅可能改变手术期间的麻醉需求，还可能改变术后镇痛管理，在这一关键时期带来了许多挑战。在这篇综述中，我们分析了肥胖患者术后阿片类药物镇痛管理的研究。我们讨论了疼痛和肥胖共有的遗传因素，以及可能改变肥胖患者阿片类药物药代动力学和药效学的因素，并分析了阿片类药物在肥胖患者术后镇痛管理中的总体疗效和安全性。手术方法的改变和额外的镇痛治疗以减少对阿片类药物的需求，可能会改善肥胖患者的早期康复和护理质量，并减少不良反应。
