Obesity Surgery

, Volume 23, Issue 11, pp 1880–1884

Gender-Related Difference in Postoperative Pain After Laparoscopic Roux-En-Y Gastric Bypass in Morbidly Obese Patients

  • Ahed Zeidan
  • Sultan Al-Temyatt
  • Hany Mowafi
  • Tharwat Ghattas
Original Contributions

Abstract

Some evidence exist to suggest that women experience more pain and require more medication than men to achieve a similar state of analgesia. However, this was not studied in morbidly obese patients. The study evaluates the effect of gender on postoperative pain and analgesic consumption in the first 24 h in morbidly obese patients who undergo laparoscopic Roux-En-Y gastric bypass surgery (RYNGPB). One hundred thirty obese adult patients who underwent elective RYNGPB were included in the study. Postoperative pain scores were compared using a numeric rating scale, at intervals (0, 15, 30, 45, 60, 90, and 120 min), and following discharge from the postanesthesia care unit (PACU) at 6, 12, and 24 h. Titrated morphine dose during the 2-h PACU stay and pethidine consumption in the subsequent 24 h were measured. One hundred fourteen patients completed the study (59 females and 55 males). Female patients had higher initial pain scores and higher morphine consumption (10.1 ± 3.1 mg) than male patients (7.2 ± 4.5 mg), P = 0.0001. Following PACU discharge, there was no gender difference in pain scores or analgesic consumption. Pethidine consumption in male patients during the first day was 97.8 ± 35.1 versus 98.1 ± 61.6 mg among female patients, P = 0.9729. Female patients had higher initial pain score and morphine consumption than men in the immediate postoperative period, but that difference disappeared after discharge from PACU.

Keywords

Gender Postoperative pain PACU Laparoscopic Roux-en-Y gastric bypass surgeries 

References

  1. 1.
    Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97(5):1464–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosseland LA, Stubhaug A. Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain. 2004;112(3):248–53.PubMedCrossRefGoogle Scholar
  3. 3.
    Unruh AM. Gender variations in clinical pain experience. Pain. 1996;65(2–3):123–67. Review.PubMedCrossRefGoogle Scholar
  4. 4.
    Kest B, Sarton E, Dahan A, et al. Gender differences in opioid mediated analgesia. Animal and human studies. Anesthesiology. 2000;93(2):539–47. Review.PubMedCrossRefGoogle Scholar
  5. 5.
    Fillingim RB, King CD, Ribeiro-Dasilva MC, et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Aubrun F, Salvi N, Coriat P, et al. Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology. 2005;103(1):156–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Lemmens HJ. Perioperative pharmacology in morbid obesity. Curr Opin Anaesthesiol. 2010;23(4):485–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Collins JS, Lemmens HJ, Brodsky JB, et al. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg. 2004;14(9):1171–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Pai MP, Paloucek FP. The origin of the “ideal” body weight equations. Ann Pharmacol. 2000;34:1066–9.CrossRefGoogle Scholar
  10. 10.
    Banicek J, Butcher D. Acute pain management following Roux-en-Y gastric bypass surgery. Nurs Stand. 2011;25(18):35–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Gelb K, Gelb AW. Sex and gender in the perioperative period: wake up to reality. Anesth Analg. 2008;107(1):1–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Chin ML, Rosenquist R. Sex, gender, and pain: “men are from Mars, women are from Venus…”. Anesth Analg. 2008;107(1):4–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Coffman BL, King CD, Rios GR, et al. The glucuronidation of opioids, other xenobiotics, and androgens by human UGT2B7Y (268) and UGT2B7H (268). Drug Metab Dispos. 1998;26(1):73–7.PubMedGoogle Scholar
  14. 14.
    Van Dorp EL, Romberg R, Sarton E, et al. Morphine-6-glucuronide: morphine's successor for postoperative pain relief? Anesth Analg. 2006;102(6):1789–97. Review.PubMedCrossRefGoogle Scholar
  15. 15.
    Peckham EM, Traynor JR. Comparison of the antinociceptive response to morphine and morphine-like compounds in male and female Sprague–Dawley rats. J Pharmacol Exp Ther. 2006;316(3):1195–201.PubMedCrossRefGoogle Scholar
  16. 16.
    Barsky AJ, Peekna HM, Borus JF, et al. Somatic symptom reporting in women and men. J Gen Intern Med. 2001;16:266–75.PubMedCrossRefGoogle Scholar
  17. 17.
    Paulson PE, Minoshima S, Morrow TJ, et al. Gender differences in pain perception and patterns of cerebral activation during noxious heat stimulation in humans. Pain. 1998;76(1–2):223–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Zubieta JK, Smith YR, Bueller JA, et al. mu-Opioid receptor-mediated antinociceptive responses differ in men and women. J Neurosci. 2002;22(12):5100–7.PubMedGoogle Scholar
  19. 19.
    Cottam DR, Fisher B, Atkinson J, et al. A randomized trial of bupivicaine pain pumps to eliminate the need for patient controlled analgesia pumps in primary laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2007;17(5):595–600.PubMedCrossRefGoogle Scholar
  20. 20.
    Uchiyama K, Kawai M, Tani M, et al. Gender differences in postoperative pain after laparoscopic cholecystectomy. Surg Endosc. 2006;20(3):448–51.PubMedCrossRefGoogle Scholar
  21. 21.
    De Baerdemaeker LE, Jacobs S, Pattyn P, et al. Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs. sufentanil TCI in morbid obesity. Br J Anaesth. 2007;99(3):404–11.PubMedCrossRefGoogle Scholar
  22. 22.
    DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Int Med. 1916;17:863–71.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ahed Zeidan
    • 1
  • Sultan Al-Temyatt
    • 2
  • Hany Mowafi
    • 3
  • Tharwat Ghattas
    • 4
  1. 1.Department of Anesthesiology and Pain MedicineProcare Riaya HospitalAl-KhobarKingdom of Saudi Arabia
  2. 2.Department of Bariatric Surgery, Badana ClinicMouwasat HospitalDammamKingdom of Saudi Arabia
  3. 3.Department of Anesthesiology and Critical CareKing Fahed Hospital of the University, University of DammamAl-KhobarKingdom of Saudi Arabia
  4. 4.Department of Anesthesiology and Pain MedicineProcare Riaya HospitalAl-KhobarKingdom of Saudi Arabia

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