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Regional anesthesia in obese patients: Challenges, considerations, and solutions
Alessandro De Cassai1,2, Francesco Zarantonello2, Elisa Pistollato2
1Department of Medicine - DIMED, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
Saudi Journal of Anaesthesia
|April 21, 2025
Summary
Regional anesthesia in obese patients presents unique challenges due to respiratory issues and altered drug distribution. Anesthesiologists must adapt techniques and dosages for safe and effective pain management in obesity.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Obesity Medicine
Background:
- Global obesity rates are rising, posing significant challenges for anesthesiologists.
- Obesity complicates regional anesthesia due to respiratory compromise, altered pharmacokinetics, and anatomical landmark difficulties.
Purpose of the Study:
- To review the challenges and strategies for performing regional anesthesia in obese patients.
- To highlight the importance of adapting techniques for patient safety and anesthetic effectiveness.
Main Methods:
- Discussion of physiological changes in obese patients affecting anesthesia.
- Review of modified techniques for ultrasound-guided regional blocks.
- Emphasis on dosage adjustments based on lean body weight.
Main Results:
- Obesity leads to reduced respiratory reserve and increased risk of hypoventilation.
- Altered body composition necessitates adjusted local anesthetic dosing.
- Excess adipose tissue impedes landmark identification and ultrasound imaging.
Conclusions:
- Adapting drug dosages, using specialized equipment, and continuous monitoring are crucial.
- Optimizing ultrasound guidance requires specific techniques like low-frequency transducers.
- A comprehensive approach addressing technical and pathological challenges ensures safe regional anesthesia in obese individuals.
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