Perioperative Pain Perception and Analgesic Requirements in Pediatric Patients with Obesity

There were 40 million children under the age of 5 and more than 340 million individuals between the ages of 5 and 19 whose BMI put them in the categories of overweight/obesity in 2018, according to the World Health Organization.1 Despite the increasing proportion of pediatric patients with obesity, there is little data about pain sensitivity and analgesic requirements in this population.

In adult patients with obesity, evidence suggests different opioid requirements following surgery to achieve optimum recovery. This could be secondary to altered perception of pain and differences in pharmacokinetics and pharmacodynamics of analgesic medications. Unfortunately there is a lack of such clinical evidence among the population of pediatric patients with obesity. It is also unclear whether obese children should receive analgesics according to their ideal body weight, potentially exposing them to underdosing and sub-optimal pain control, or according to their actual body weight, with the inherent risks of toxicity and opioid-induced side effects, such as respiratory depression or nausea/vomiting.

To address this, in a single-center retrospective cohort study, led by Alparslan Turan, MD, Vice Chairman of Outcomes Research and Staff at Cleveland Clinic’s Anesthesiology Institute, Surendrasingh Chhabada, MD, a pediatric anesthesiologist with Cleveland Clinic Children’s, together with collaborators, analyzed postoperative pain scores and opioid consumption in opioid-naïve patients between the ages of 8 and 18 who had elective, noncardiac surgery with an inpatient stay of at least 48 hours at Cleveland Clinic Children’s between 2010 and 2015.2 The authors found no clinically important association between BMI and postoperative pain or opioid requirement. These results suggest that clinicians can follow a similar dosing approach in obese and non-obese patients between 8-18 years of age when administering opioids in the perioperative period.

References

1. World Health Organization. Overweight and obesity. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Updated April 1, 2020. Retrieved August 24, 2020.
2. Cohen B, Tanios MA, Koyuncu O, et al. Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – a retrospective cohort study. J Clin Anesth. 2020 Jun;62:109729.