Abstract：
BACKGROUND: Obesity prevalence is persistently increasing worldwide. Among surgical therapeutic procedures, bypass surgery and sleeve gastrectomy have shown the best results regarding weight loss, prevention, and treatment of secondary complications. However, these surgeries are associated with an increased risk of malabsorption and metabolic changes that could further affect the pharmacokinetics of drugs. On the other hand, patients with a history of such surgeries are more likely to experience pain and request analgesic initiation or adaptation. The question of how to manage pain medication in these patients is challenging due to their narrow therapeutic indexes.
OBJECTIVE: To summarize the current literature on the impact of bariatric surgery on the subsequent pharmacokinetics of analgesics and propose a multidisciplinary therapeutic attitude to optimize pain management in these patients.
METHODS: We conducted a systematic review that included all pharmacological studies published after 2000.
RESULTS: Unexpectedly, these surgeries seem to increase the bioavailability of drugs by long-term improvement of hepatic function. Yet, the medical community drastically lacks robust guidelines for pain management in those patients. This systematic review aims to bring together pharmacological studies related to the use of pain treatments in patients who underwent bypass surgery or sleeve gastrectomy.
CONCLUSIONS: Caution should be exercised regarding the risk of overdose in every circumstance: treatment initiation, change of doses, or change of molecule. More prospective trials comparing the pharmacokinetics of medications in obese patients with and without prior bariatric surgery are needed.
OBJECTIVE: To summarize the current literature on the impact of bariatric surgery on the subsequent pharmacokinetics of analgesics and propose a multidisciplinary therapeutic attitude to optimize pain management in these patients.
METHODS: We conducted a systematic review that included all pharmacological studies published after 2000.
RESULTS: Unexpectedly, these surgeries seem to increase the bioavailability of drugs by long-term improvement of hepatic function. Yet, the medical community drastically lacks robust guidelines for pain management in those patients. This systematic review aims to bring together pharmacological studies related to the use of pain treatments in patients who underwent bypass surgery or sleeve gastrectomy.
CONCLUSIONS: Caution should be exercised regarding the risk of overdose in every circumstance: treatment initiation, change of doses, or change of molecule. More prospective trials comparing the pharmacokinetics of medications in obese patients with and without prior bariatric surgery are needed.
摘要：
肥胖患病率在世界范围内持续增加。在手术治疗程序中，旁路手术和袖状胃切除术显示出最佳的减肥效果，预防,和继发性并发症的治疗。然而,这些手术与吸收不良和代谢变化的风险增加有关，这可能进一步影响药物的药代动力学。另一方面,有此类手术史的患者更有可能出现疼痛,并要求开始或适应镇痛.由于这些患者的治疗指标狭窄，因此如何管理止痛药的问题具有挑战性。出乎意料的是,这些手术似乎通过长期改善肝功能来增加药物的生物利用度。然而，医学界严重缺乏对这些患者进行疼痛管理的有力指南.本系统综述旨在汇集与在接受搭桥手术或袖状胃切除术的患者中使用疼痛治疗相关的药理学研究。在主要结论中,在每种情况下都应谨慎对待过量的风险：治疗开始，改变剂量,或者分子的变化。需要进行更多前瞻性试验，比较有和没有进行减肥手术的肥胖患者药物的药代动力学。
