Abstract
Background: Obesity, particularly in the setting of comorbid disease, presents a unique challenge. Clinicians are pursuing areas of multimodal analgesia in an effort to minimize narcotic dosages. Post-operatively, their pain management can be even more challenging, which includes appropriate use of narcotics in a patient that has a high probably of sleep apnea. Aim: To show that the use of liposomal bupivacaine (Exparel) can provide effective post-operative pain relief and decrease the use of post-operative narcotics. Case: We report on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy with a lymph node dissection. At the end of the case, the patient’s wound was infiltrated with both free bupivacaine and Exparel that minimized her need for post-operative narcotics. Conclusion: We believe that the use of extended release local anesthetics should be considered when there is a need to reduce the use of post-operative narcotics.
Highlights
Obese patients are known to present challenges to the anesthesia care team
We are reporting on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy
Patients with long standing smoking history have a high probability of chronic obstructed pulmonary disease (COPD)
Summary
Obese patients are known to present challenges to the anesthesia care team. Obese patients have a higher inci-. We are reporting on a 62 years old female with a history of hypertension, obesity and a greater than a 40 pack year history of smoking who presented for a modified radical mastectomy. Past medical history included hypertension (HTN), a 40 plus pack year history of smoking: chronic obstructed pulmonary disease (COPD) and significant obesity: her height was 61 inches, weight was 88 kg with a BMI of 37. She reported no drug allergies and was on HCTZ,, Amlodipine, Fosinospril, Metoprolol for her HTN, Simvastatin for high cholesterol, Asastrozole for her breast cancer and on aspirin a day. A discussion was had with the surgeon preoperatively with respect to the use of long acting bupivacaine and to minimize the use of narcotic postoperative, secondary to her weight and long smoking history
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