Abstract
Purpose of Review
With the rise of the opioid epidemic, anesthesiologists will find themselves faced with opioid-addicted patients more frequently. Addiction to opioids may also occur concurrently with abuse of other non-opioid medications. Our review article seeks to outline an armamentarium of pain management strategies in the perioperative period for these patients with addiction to opioid and non-opioid medications.
Recent Findings
Statistics from the CDC demonstrate a shocking increase in opioid prescription rates and opioid-related deaths. Furthermore, opioid-addicted patients have notoriously undertreated pain in the perioperative period. A multitude of strategies are available in the perioperative period to treat pain in these patients.
Summary
Formulating treatment plans for opioid and non-opioid-addicted patients undergoing surgery should include considerations in the pre-, intra-, and post-operative period. Our review article outlines several non-opioid modalities which may be employed to treat pain in these patients; however, particularly in the opioid-addicted population, the practitioner must be aware that non-opioids alone may not suffice to treat post-surgical pain. Consultation with pain management may be warranted to optimize opioid and non-opioid treatment for these patients.
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References
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Rothstein MA. The opioid crisis and the need for compassion in pain management. Am J Public Health. 2017;107(8):1253–4.
Roger Chou DBG, de Leon-Casasola OA, Rosenberg JM, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57.
Medicine, A.S.O.A., Definitions related to the use of opioids for the treatment of pain: consensus statement of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine 2001.
Hah JMM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Analg. 2017;125(5):1733–40.
Ballantyne JC, LaForge KS. Opioid dependence and addiction during opioid treatment of chronic pain. Pain. 2007;129:235–55.
Niikura K, Narita M, Butelman ER, Kreek MJ, Suzuki T. Neuropathic and chronic pain stimuli downregulate central mu-opioid and dopaminergic transmission. Trends Pharmacol Sci. 2010;31(7):299–305.
Rai AS, Khan JS, Dhaliwal J, Busse JW, Choi S, Devereaux PJ, et al. Preoperative pregabalin or gabapentin for acute and chronic postoperative pain among patients undergoing breast cancer surgery: a systematic review and meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg. 2017;70:1317–28.
Bo Liu RL, Wang L. A meta-analysis of the preoperative use of gabapentinoids for the treatment of acute postoperative pain following spinal surgery. Medicine. 2017;96(37):e8031.
Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology. 2013;119(5):1215–21.
Carroll IR, Angst MS, Clark JD. Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004;29(6):576–91.
Mathiesen O, Wetterslev J, Kontinen VK, Pommergaard HC, Nikolajsen L, Rosenberg J, et al. Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations:a topical review. Acta Anaesthesiol Scand. 2014;58:1182–98.
Westhuizen J, Kuo PY, Reed PW, Holder K. Randomised controlled trial comparing oral and intravenous paracetamol (acetaminophen) plasma levels when given as preoperative analgesia. Anaesth Intensive Care. 2011;39:242–6.
• Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Acute pain management in opioid-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011;39:804–23. An excellent article reviewing the current opioid crisis and strategies to treat acute pain in opioid addicted patients.
Sang Hun Kim NS, Soghomonyan S, Bergese SD. Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: a systemic review. Front Pharmacol. 2014;5(108):1–9.
White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5 Suppl):S5–22.
Enas Kandil EM, Adinoff B. Lidocaine infusion: a promisint therapeutic approach for chronic pain. J Anesthesia Clin Res. 2017;8(1):697.
Prerana N Shah YD. Magnesium sulfate for postoperative analgesia after surgery under spinal anesthesia. Acta Anesthesiol Taiwanica. 2016;54(2):62–4.
Neilsen R, Fomsgaard JS, Siegel H, Martusevicius R, Nikolajsen L, Dahl J, et al. Intraoperative ketamine reduces immediate postoperative opioid consumption after spinal fusion surgery in chronic pain patients with opioid dependency: a randomized, blinded trial. Pain. 2017;158(3):463–70.
Grosu I, Lavand’homme P. Use of dexmedetomidine for pain control. F1000 Med Rep. (2010) 2(90).
Vadivelu N, Gowda A, Urman D, Jolly S, Kodumudi V, Maria M, et al. Ketorolac tromethamine—routes and clinical implications. Pain Pract. 2014;15(2):175–93.
Bookstaver PB, Miller A, Rudisill C, Norris L. Intravenous ibuprofen: the first injectable product for the treatment of pain and fever. J Pain Res. 2010;3:67–79.
Southworth S, Woodward E, Peng A, Rock A. An integrated safety analysis of intravenous ibuprofen (Caldolor) in adults. J Pain Res. 2015;8:753–65.
Liu Q, Michael M. Opioid-induced loss of local anesthetic potency in the rat sciatic nerve. Anesthesiology. 2016;125(4):755–64.
Mehta V, Langford RM. Acute pain management for opioid dependent patients. Anaesthesia. 2006;61(3):269–76.
Mitra MDS, Raymond MDPD, Sinatra S. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology. 2004;101(1):212–27.
• Quinlan J, Cox F. Acute pain management in patients with drug dependence syndrome. PAIN Rep. 2017;2(4):e611. A comprehensive and unique article addressing management of patients abusing non-opioid drugs.
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Donna-Ann Thomas, Praba Boominathan, Jyotsna Goswami, Sudipta Mukherjee, and Nalini Vadivelu declare no conflict of interest.
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This article is part of the Topical Collection on Other Pain
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Thomas, DA., Boominathan, P., Goswami, J. et al. Perioperative Management of Patients with Addiction to Opioid and Non-opioid Medications. Curr Pain Headache Rep 22, 52 (2018). https://doi.org/10.1007/s11916-018-0704-6
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DOI: https://doi.org/10.1007/s11916-018-0704-6