title: Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review.
abstract: The patient with a history of current opioid consumption presenting in the acute postoperative setting presents a challenge for pain management. Standard treatment dosages and strategies are often ineffective in providing pain relief. This retrospective case-control study reviews 4 years' experience of the Acute Pain Service (APS) at our institution providing care for 202 chronic pain and opioid-consuming (CPOC) patients, 6.6% of 3058 patients undergoing urologic, gynecologic, orthopedic and general surgical procedures. Controls matched for age, gender, date and type of surgery, and postoperative pain relief modality were found for 180 (89%) of these patients. Patients were provided patient-controlled analgesia (PCA), or epidural opioid analgesia (EOA with boluses of preservative-free morphine or bupivacaine (1:16% + 2 micrograms/ml fentanyl (B/F)). Records were reviewed for patient demographics, diagnoses, surgical procedures, pre-operative opioid use, days-on-service, analgesic requirement, pain scores and incidence of moderate/severe side effects. Patient demographics were similar between CPOC and control groups. When considering PCA alone, mean 24-h usage in controls was 42.8 (32.0) mg morphine (MS) equivalents differing significantly from CPOC patients' use of 135.8 (68.5) mg MS equivalents (P = 0.0001). EOA and B/F case studies showed similar results. Moderate sedation was experienced by 50% of CPOC patients receiving PCA. Differences in opioid usage, side effects, pain scores, sedation and prescribed treatment with anxiolytics were shown between CPOC patients and matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anesthesiology, RN-10, University of Washington School of Medicine, Seattle, WA 98195, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Rapp
authors.forename: Brian L
authors.initials: BL
authors.lastname: Ready
authors.forename: Michael L
authors.initials: ML
authors.lastname: Nessly
mesh_terms: D000208:Acute Disease; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care; D011300:Preoperative Care; D012189:Retrospective Studies; D012646:Self Administration
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine