How to Reduce Opioid Use following Bariatric Surgery?

The number of people undergoing surgery in order to lose weight and control the complications of morbid obesity is increased in recent years. Although bariatric surgery is actually mainly performed laparoscopically, analgesic optimization continues being essential to reduce complications and to improve the patient's comfort [1]. Despite minimally invasive nature of laparoscopic bariatric surgery, pain can be moderate to severe in the immediate postoperative period [2]. Pain control after bariatric surgery may be especially challenging because of increased sensitivity of the obese patient to opioid-induced respiratory depression [2-4]. Morbidly obese patients, due to high incidence of obstructive sleep apnea, are predisposed to opioid induced airway obstruction and scientific guidelines emphasize the importance of opioid-sparing analgesic approach in over-weighted patients [5,6]. Morbidly obese patients need a multimodal analgesic technique which can offer analgesia without significant adverse effects on the respiratory function. First of all, let me remind that the somatic component of post-bariatric surgery pain originates from the trocar insertion sites. It seems logical to reduce the number of trocars to provide reduction in postoperative pain.