May We Consider the Use of Nalbuphine as Postoperative Opioid in Bariatric Patients?

Abstract

0,307/ 0,284, respectively, and the pooled RR was 0.78 (95%CI, 0.602–0.997; P = 0.048) for nausea, 0.65 (95%CI, 0.50–0.85; P = 0.001) for vomiting. The incidence of respiratory depression with Nalbuphine and Morphine was 0,075 and 0,197, respectively, and the pooled RR was 0.27 (95%CI, 0.12–0.57; P = 0.001). The most serious side effect of opioid use is respiratory depression. Nalbuphine has a plateau effect on respiratory depression, and it has been shown to reverse the respiratory depression from both intravenous [18] and epidural [19] mu-opioids. Because of the growing number of indications and performance of bariatric surgeries, more obese patients are being admitted in the Intensive Care Unit (ICU) [20]. Among factors predisposing to admission in the ICU are mentioned: male gender, age ≥ 50 years BMI ≥ 60 Kg/m2, diabetes mellitus, OSAS, cardiopathies, venous difficulty and complications in the intra or immediate postoperative [20,21] mainly due to respiratory complications such as pneumonia, thromboembolic disease, respiratory failure requiring mechanical ventilation and to a lesser extent, respiratory arrest [21-23]. Postoperative complications and stay in the ICU increase hospital costs [22]. The opposite is also true, fewer complications reduce hospital stay and therefore lessen hospital costs [24]. At postoperative, obeses present difficulties in early mobilization. Immobility increases the risk of adverse thromboembolitic events, especially in surgeries of the upper abdomen [24]. On the other hand, early walking reduces the risk of pulmonary thromboembolism and other respiratory problems at postoperative affording and improving lung expansion, minimizing and reverting atelectasias formed by the prolonged decubitus in the bed [20].