Skip to main content

Is There a Role for Regional Anesthesia in the Obese Patient?

  • Chapter
  • First Online:
Controversies in the Anesthetic Management of the Obese Surgical Patient
  • 813 Accesses

Abstract

Regional anesthesia may have potential advantages compared to general anesthesia for select surgical procedures in obese patients. Even when general anesthesia is necessary, the addition of a regional anesthesia technique for postoperative analgesia may decrease requirements for supplemental systemic analgesics and therefore reduce the incidence of opioid-induced side effects. This may be particularly beneficial in obese patients with obstructive sleep apnea (OSA) syndrome. However, obese patients present technical challenges to the anesthesia practitioner due to unfamiliar surface anatomy and difficulty assuming positions optimal for procedural performance. Surface ultrasound is emerging as a useful tool for regional anesthesia in obese patients for pre-procedural scanning to establish the site for needle insertion and target location or for real-time needle guidance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Liu B, Balkwill A, Banks E et al (2007) Relationship of height, weight and body mass index to the risk of hip and knee replacements in middle-aged women. Rheumatology (Oxford) 46:861–867

    Article  CAS  Google Scholar 

  2. Mulhall KJ, Ghomrawi HM, Mihalko W et al (2007) Adverse effects of increased body mass index and weight on survivorship of total knee arthroplasty and subsequent outcomes of revision TKA. J Knee Surg 20:199–204

    PubMed  Google Scholar 

  3. Vincent HK, Vincent KR (2008) Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study. Obesity (Silver Spring) 16:130–136

    Article  Google Scholar 

  4. Dixon T, Shaw M, Ebrahim S, Dieppe P (2004) Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis 63:825–830

    Article  PubMed  CAS  Google Scholar 

  5. Hadzic A, Kerimoglu B, Loreio D et al (2006) Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair. Anesth Analg 102:1076–1081

    Article  PubMed  CAS  Google Scholar 

  6. Hadzic A, Williams BA, Karaca PE et al (2005) For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology 102:1001–1007

    Article  PubMed  CAS  Google Scholar 

  7. Liu SS, Strodtbeck WM, Richman JM et al (2005) A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 101:1634–1642

    Article  PubMed  Google Scholar 

  8. Brodsky JB, Mariano ER (2011) Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol 25:61–72

    Article  PubMed  CAS  Google Scholar 

  9. Brodsky JB, Merrell RC (1984) Epidural administration of morphine postoperatively for morbidly obese patients. West J Med 140:750–753

    PubMed  CAS  Google Scholar 

  10. von Ungern-Sternberg BS, Regli A et al (2004) Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section. Anaesthesia 59:743–749

    Article  Google Scholar 

  11. Regli A, von Ungern-Sternberg BS et al (2006) Impact of spinal anaesthesia on peri-operative lung volumes in obese and morbidly obese female patients. Anaesthesia 61:215–221

    Article  PubMed  CAS  Google Scholar 

  12. Casati A, Putzu M (2005) Anesthesia in the obese patient: pharmacokinetic considerations. J Clin Anesth 17:134–145

    Article  PubMed  CAS  Google Scholar 

  13. Busetto L, Enzi G, Inelmen EM et al (2005) Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon. Chest 128:618–623

    Article  PubMed  Google Scholar 

  14. Grunstein RR, Stenlof K, Hedner JA et al (2007) Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep 30:703–710

    PubMed  Google Scholar 

  15. Gross JB, Bachenberg KL, Benumof JL et al (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American society of anesthesiologists task force on perioperative management of patients with obstructive sleep apnea. Anesthesiology 104:1081–1093

    Article  PubMed  Google Scholar 

  16. Capdevila X, Barthelet Y, Biboulet P et al (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91:8–15

    Article  PubMed  CAS  Google Scholar 

  17. Ilfeld BM, Vandenborne K, Duncan PW et al (2006) Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology 105:999–1007

    Article  PubMed  Google Scholar 

  18. Borgeat A, Schappi B, Biasca N et al (1997) Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology 87:1343–1347

    Article  PubMed  CAS  Google Scholar 

  19. Mariano ER, Afra R, Loland VJ et al (2009) Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg 108:1688–1694

    Article  PubMed  CAS  Google Scholar 

  20. Mariano ER, Brodsky JB (2011) Comparison of procedural times for ultrasound-guided perineural catheter insertion in obese and nonobese patients. J Ultrasound Med 30:1357–1361

    PubMed  Google Scholar 

  21. Michaloudis D, Fraidakis O, Petrou A et al (2000) Continuous spinal anesthesia/analgesia for perioperative management of morbidly obese patients undergoing laparotomy for gastroplastic surgery. Obes Surg 10:220–229

    Article  PubMed  CAS  Google Scholar 

  22. Zaric D, Boysen K, Christiansen C et al (2006) A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg 102:1240–1246

    Article  PubMed  Google Scholar 

  23. Karmakar MK (2001) Thoracic paravertebral block. Anesthesiology 95:771–780

    Article  PubMed  CAS  Google Scholar 

  24. Naja Z, Ziade MF, Lonnqvist PA (2002) Bilateral paravertebral somatic nerve block for ventral hernia repair. Eur J Anaesthesiol 19:197–202

    PubMed  CAS  Google Scholar 

  25. Boezaart AP, Raw RM (2006) Continuous thoracic paravertebral block for major breast surgery. Reg Anesth Pain Med 31:470–476

    PubMed  Google Scholar 

  26. Hebbard P, Fujiwara Y, Shibata Y et al (2007) Ultrasound-guided transversus abdominis plane (TAP) block. Anaesth Intensive Care 35:616–617

    PubMed  CAS  Google Scholar 

  27. O’Donnell BD, McDonnell JG, McShane AJ (2006) The transversus abdominis plane (TAP) block in open retropubic prostatectomy. Reg Anesth Pain Med 31:91

    PubMed  Google Scholar 

  28. Tran TM, Ivanusic JJ, Hebbard P et al (2009) Determination of spread of injectate after ultrasound-guided transversus abdominis plane block: a cadaveric study. Br J Anaesth 102:123–127

    Article  PubMed  CAS  Google Scholar 

  29. Barrington MJ, Ivanusic JJ, Rozen WM et al (2009) Spread of injectate after ultrasound-guided subcostal transversus abdominis plane block: a cadaveric study. Anaesthesia 64:745–750

    Article  PubMed  CAS  Google Scholar 

  30. Costello JF, Moore AR, Wieczorek PM et al (2009) The transversus abdominis plane block, when used as part of a multimodal regimen inclusive of intrathecal morphine, does not improve analgesia after cesarean delivery. Reg Anesth Pain Med 34:586–589

    Article  PubMed  Google Scholar 

  31. Heil JW, Ilfeld BM, Loland VJ (2010) Ultrasound-guided transversus abdominis plane catheters and ambulatory perineural infusions for outpatient inguinal hernia repair. Reg Anesth Pain Med 35:556–558

    Article  PubMed  Google Scholar 

  32. Nielsen KC, Guller U, Steele SM et al (2005) Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology 102:181–187

    Article  PubMed  Google Scholar 

  33. Broadbent CR, Maxwell WB, Ferrie R et al (2000) Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 55:1122–1126

    Article  PubMed  CAS  Google Scholar 

  34. Sprung J, Bourke DL, Grass J et al (1999) Predicting the difficult neuraxial block: a prospective study. Anesth Analg 89:384–389

    PubMed  CAS  Google Scholar 

  35. Perlas A (2010) Evidence for the use of ultrasound in neuraxial blocks. Reg Anesth Pain Med 35:S43–S46

    Article  PubMed  Google Scholar 

  36. Carvalho JC (2008) Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin 26:145–158 (vii–viii)

    Google Scholar 

  37. Karmakar MK, Li X, Ho AM (2009) Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth 102:845–854

    Article  PubMed  CAS  Google Scholar 

  38. Brull R, Lupu M, Perlas A et al (2009) Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance. Can J Anaesth 56:812–818

    Article  PubMed  Google Scholar 

  39. Casati A, Baciarello M, Di Cianni S et al (2007) Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth 98:823–827

    Article  PubMed  CAS  Google Scholar 

  40. Mariano ER, Loland VJ, Bellars RH et al (2009) Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion. J Ultrasound Med 28:1211–1218

    PubMed  Google Scholar 

  41. Schwemmer U, Papenfuss T, Greim C et al (2006) Ultrasound-guided interscalene brachial plexus anaesthesia: differences in success between patients of normal and excessive weight. Ultraschall Med 27:245–250

    Article  PubMed  CAS  Google Scholar 

  42. Sites BD, Chan VW, Neal JM et al (2009) The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy joint committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 34:40–46

    Article  PubMed  Google Scholar 

  43. Ihnatsenka B, Boezaart AP (2010) Ultrasound: basic understanding and learning the language. Int J Shoulder Surg 4:55–62

    Article  PubMed  Google Scholar 

  44. Tsui BC, Kropelin B (2005) The electrophysiological effect of dextrose 5% in water on single-shot peripheral nerve stimulation. Anesth Analg 100:1837–1839

    Article  PubMed  Google Scholar 

  45. Taivainen T, Tuominen M, Rosenberg PH (1990) Influence of obesity on the spread of spinal analgesia after injection of plain 0.5% bupivacaine at the L3–4 or L4–5 interspace. Br J Anaesth 64:542–546

    Article  PubMed  CAS  Google Scholar 

  46. Hodgkinson R, Husain FJ (1980) Obesity and the cephalad spread of analgesia following epidural administration of bupivacaine for Cesarean section. Anesth Analg 59:89–92

    PubMed  CAS  Google Scholar 

  47. Scott DB, Jebson PJ, Braid DP et al (1972) Factors affecting plasma levels of lignocaine and prilocaine. Br J Anaesth 44:1040–1049

    Article  PubMed  CAS  Google Scholar 

  48. Ostad A, Kageyama N, Moy RL (1996) Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 22:921–927

    Article  PubMed  CAS  Google Scholar 

  49. de Jong RH, Grazer FM (2001) Perioperative management of cosmetic liposuction. Plast Reconstr Surg 107:1039–1044

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Edward R. Mariano .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Italia

About this chapter

Cite this chapter

Kim, T.E., Mariano, E.R. (2013). Is There a Role for Regional Anesthesia in the Obese Patient?. In: Leykin, Y., Brodsky, J. (eds) Controversies in the Anesthetic Management of the Obese Surgical Patient. Springer, Milano. https://doi.org/10.1007/978-88-470-2634-6_21

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2634-6_21

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2633-9

  • Online ISBN: 978-88-470-2634-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics