Postoperative analgesia in laparoscopic cholecystectomy in obese patients

Abstract

Obesity is an excessive or aberrant buildup of fat in the adipose tissue to the point where it compromises health. An estimated 6% of adults have grade 3 obesity (BMI ≥40), while one-third of individuals are obese, defined as having a body mass index (BMI) of 30 or above. This subgroup is especially vulnerable to the effects of opioids and anesthetics due to the combination of chronic hypoxemia and hypercapnia, which can cause acute and persistent hypoventilation as well as respiratory arrest in the early postoperative phase. The three types of pain following laparoscopic cholecystectomy are somatic (incisional), visceral (deep intra-abdominal), and shoulder pain. The intensity and duration of these pains vary greatly between individuals. In the first 24 hours following surgery, visceral discomfort from the trauma of gallbladder resection and diaphragmatic irritation from the CO2 pneumoperitoneum appears to be more noticeable. Coughing exacerbates this pain, which is unaffected by mobilization. The analgesic strategy should be multimodal because of the complexity of pain following laparoscopic cholecystectomy.