Spinal Anesthesia in Morbidly Obese Patients: Risks, Benefits, and Future Perspectives

Background : Morbid obesity is associated with unique physiological alterations that elevate the risk of perioperative complications. Spinal anesthesia represents a promising approach that may reduce the risks related to general anesthesia; however, its safety and efficacy in morbidly obese patients require further investigation. Objective : To evaluate the safety, efficacy, and potential benefits of spinal anesthesia in morbidly obese patients and to develop recommendations for minimizing associated risks. Materials and Methods : An analysis of 12 studies (2013–2023) involving over 1,500 morbidly obese patients was conducted. Clinical outcomes, complication rates, and patient satisfaction were evaluated. Data from randomized controlled trials, meta-analyses, and large cohort studies were utilized. Results : Spinal anesthesia in morbidly obese patients is associated with fewer respiratory complications (odds ratio 0.4; 95% CI 0.3–0.6), reduced opioid requirements, and shorter recovery time compared to general anesthesia. However, technical challenges due to anatomical characteristics, an increased risk of hypotension (15%), and a moderately higher incidence of post-dural puncture headache (3%) were observed. Conclusions : Spinal anesthesia may be a safe and effective option for morbidly obese patients when thorough planning and monitoring are implemented.