Opioid Requirements After Laparoscopic Bariatric Surgery

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.