Regional anaesthesia in obese patient

Objective. - To detail specificity of regional anaesthesia techniques in the obese patient. Data sources. - Articles were selected from Medline database using the combination of the following keywords: obesity, peripheral nerve block, spinal anaesthesia, epidural, morbidity, mortality. Study selection. - Most recent original articles or review have mainly been selected. Some case reports that highlighted specific points were added. Data extraction. - Articles were analyzed for advantages and drawbacks, and risks of different techniques in obese patient. Data synthesis. - Techniques avoiding obese patient's mobilization are recommended. The use of skin landmarks may be challenging for both central and peripheral blocks. Ultrasound techniques should improve block performance, even though deep fat layers seem limit sound diffusion. Success rate and incidence of complications are usually increased after regional anaesthesia technique in obese patient. The reduction of intrathecal local anesthetic dose remains controversial in this population. Conclusion. - Regional anaesthesia techniques could represent an alternative to general anaesthesia (less cardiorespiratory complications). However, many specific considerations have to be taken into account. (C) 2011 Societe francaise d'anesthesie et de reanimation (Star). Published by Elsevier Masson SAS. All rights reserved.