Analgesia in the Obese Patient

Obese patients pose unique challenges to the anesthesiologist for optimal perioperative management. The perioperative universal goal of comfortable yet safe surgery is no less than a double-edged sword in the morbidly obese. In order to achieve high patient satisfaction (directly related to quality of recovery and analgesia), the anesthesiologist has to strike a delicate balance between the life-threatening adverse events and analgesic potential of opioids. Further to compound the issue, the interindividual pharmacokinetic variations in opioid effects make this job almost next to impossible. Despite these safety hurdles and pharmacological barriers, a postsurgical obese patient in pain cannot be ethically or morally justified! Over the years, gradual progress has been made in analgesic management of the morbidly obese that not only resorts to alternative analgesic regimens but also strikes a safety balance for the use of “dangerous” opioids. The “danger” here is not by any standards a misrepresentation as it can be adjudged by the fact that as per the American Society of Anesthesiologists (ASA) closed claim data, highest perioperative complications/mortality in obese occurs due to opioid-related airway complications [1].