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Updated: Dec 29, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients - A
Barak Cohen1, Marianne A Tanios2, Onur Koyuncu2
1Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America; Division of Anesthesia, Critical Care, and Pain Management, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Insights
Higher body mass index (BMI) in pediatric surgical patients was not linked to increased postoperative pain. Obese children undergoing surgery did not require more pain medication, challenging previous assumptions about pain management in this group.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Obesity Research
Background:
- Childhood and adolescent obesity rates have risen, increasing the number of pediatric surgical patients with obesity.
- Existing data suggest potential alterations in pain sensitivity and analgesic needs for obese individuals.
Purpose of the Study:
- To investigate the association between elevated body mass index (BMI) and postoperative pain in pediatric surgical patients.
- To determine if BMI correlates with increased opioid consumption in the 48 hours following surgery.
Main Methods:
- Retrospective cohort study of 808 opioid-naïve pediatric patients (8-18 years) undergoing elective non-cardiac surgery.
- Utilized U.S. CDC weight classifications to assess BMI percentile.
- Employed multivariable regression models to analyze the relationship between BMI percentile, pain scores, and opioid consumption (mg morphine equivalents/kg).
Main Results:
- No significant association was found between BMI and postoperative pain for general, orthopedic, or neuro-spinal surgeries.
- A minor increase in pain (0.07 points per 5 BMI percentile increase) was observed specifically after neuro-cranial surgery.
- Higher BMI was associated with a significant decrease in postoperative opioid consumption (2.12% per 5 BMI percentile increase).
Conclusions:
- Higher BMI in pediatric patients (8-18 years) undergoing elective non-cardiac surgery was not clinically associated with increased pain.
- Contrary to some expectations, elevated BMI did not lead to greater opioid requirements post-surgery.
Background:
Childhood and adolescent obesity increased in recent decades, and caregivers face an increasing number of obese pediatric surgical patients. Some clinical and pharmacogenetic data suggest that obese patients have altered pain sensitivity and analgesic requirements.
Objective:
To test the primary hypothesis that increased BMI in pediatric patients is associated with increased pain during the initial 48 postoperative hours. Secondarily, we tested whether BMI is associated with increased opioid consumption during the same period.
Design:
Retrospective single-center cohort study.
Setting:
Pediatric surgical wards in a tertiary medical center.
Patients:
A total of 808 opioid naïve patients aged 8 to 18 years having elective non-cardiac surgery with hospital stay of at least 48 h in the Cleveland Clinic between 2010 and 2015.
Interventions:
None.
Measurements:
Using U.S. Centers for Disease Control definitions for childhood weight classifications, we retrospectively evaluated the association between body mass index (BMI) percentile and time-weighted average pain scores and opioid consumption. We used multivariable linear regression to test for an association with postoperative pain scores, and multivariable gamma regression to test for an association with postoperative opioid consumption (in mg morphine equivalents Kg-1).
Results:
BMI was not associated with postoperative pain after general, orthopedic, or neuro-spinal surgeries. Pain increased by 0.07 [98.75% CI: (0.01, 0.13), Padj < 0.05] points per 5 percentile increase in BMI after neuro-cranial surgery. Higher BMI was associated with a decrease in postoperative opioid consumption (mean change [95% CI] -2.12% [-3.12%, -1.10%] in morphine equivalents Kg-1 per 5 percentile increase in BMI, P < 0.001).
Conclusion:
We found no clinically important increase in pain scores or opioid consumption in association with higher BMI in patients 8 to 18 years of age recovering from elective non-cardiac surgery.
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