Perioperative Management of Patients with Addiction to Opioid and Non-opioid Medications
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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.
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.
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.
KeywordsPerioperative pain management Opioid addiction and surgery
Compliance with Ethical Standards
Conflict of Interest
Donna-Ann Thomas, Praba Boominathan, Jyotsna Goswami, Sudipta Mukherjee, and Nalini Vadivelu declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 2.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.CrossRefPubMedGoogle Scholar
- 3.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.Google Scholar
- 7.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.CrossRefPubMedGoogle Scholar
- 13.• 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.PubMedGoogle Scholar
- 14.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.Google Scholar
- 16.Enas Kandil EM, Adinoff B. Lidocaine infusion: a promisint therapeutic approach for chronic pain. J Anesthesia Clin Res. 2017;8(1):697.Google Scholar
- 18.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.CrossRefGoogle Scholar
- 19.Grosu I, Lavand’homme P. Use of dexmedetomidine for pain control. F1000 Med Rep. (2010) 2(90).Google Scholar