The Obese Surgical Patient: A Need for a Strong Multimodal Analgesia Approach

Chris Pasero, MS, RN-BC

Disclosures

March 20, 2014

Clinical Presentation: An Obese Surgical Patient

A 39-year-old woman is admitted for weight-reduction surgery.

History and Physical Examination

History. The patient has a 16-year history of obesity (295 lb; body mass index [BMI], 47.6 kg/m2). She states that she never had a weight problem until she became pregnant with her son, at which time she gained nearly 100 lb. She has tried multiple methods to lose weight over the years and has always regained all lost weight and more. Her most recent attempt to lose weight involved a 3-month course of lorcaserin, which yielded a weight loss of 9 lb (3% of body weight). Feeling discouraged with the slow weight loss, she sought information about surgical intervention and is now scheduled to undergo a robotic sleeve gastrectomy.

Additional health history includes the following:

  • Other than hypertension, which has been well controlled with medication for the past 4 years, she has no other comorbid conditions.

  • Although her husband reports that she snores loudly on occasion during sleep, a preoperative sleep study revealed that the patient does not have obstructive sleep apnea (OSA) syndrome.

  • She has mild osteoarthritis pain in her left hip, which is well controlled with scheduled doses of acetaminophen.

  • She has never smoked tobacco, and alcohol consumption has always been limited to an occasional glass of wine with dinner.

  • As a full-time high school history teacher, the patient participates in multiple work-related activities, including field trips and student counseling.

  • The patient exercises regularly, including swimming at the local YM-YWCA 3 times per week.

  • Social history: She has been married for 18 years and has a son, aged 16. She is active in her son's social and sports activities, including serving as an Eagle Scout leader. With her husband and friends, she is socially active, playing bridge weekly, and attends a local weight- loss support group meeting.

  • She denies feeling depressed or anxious and says she is "looking forward to having the surgery."

  • The patient participated in a hospital-provided preoperative preparation course in which she learned about her surgical procedure, pain control, and her role in achieving established postoperative short- and long-term functional goals.

Vital signs. Preoperative vital signs are:

  • Height, 5'6"; weight, 295 lb

  • Ear temperature: 98.4°F

  • Pulse: 84 beats/min

  • Respiratory rate: 18 breaths/min

  • Oxygen (O2) saturation (pulse oximetry) on room air: 98%

  • Blood pressure: 132/86 mm Hg

Current medications

  • Daily vitamin

  • Lisinopril/hydrochlorothiazide 10 mg/12. 5 mg once daily

  • Acetaminophen 650 mg every 6 hours

  • Lorcaserin 10 mg twice daily (discontinued 2 weeks ago)

  • No known allergies

Comments

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