Management of perioperative pain in patients chronically consuming opioids.
BACKGROUND
The prevalence of licit and illicit opioid use is growing, and a greater percentage of chronically opioid-consuming patients are presenting for surgery. These patients can be expected to experience increased postoperative pain, greater postoperative opioid consumption, and prolonged use of healthcare resources for managing their pain.


METHODS
Achieving adequate pain control in these patients can be challenging because commonly used strategies for alleviating postoperative pain may have diminished effectiveness. We explore the prevalence and characteristics of opioid use in the United States and discuss its impact on the perioperative management of pain. We examine mechanistically why adequate perioperative pain control in chronically opioid-consuming patients may be difficult.


CONCLUSIONS
We present strategies for providing adequate analgesia to these patients that include the optimal use of opioids, adjuvant medications, and regional anesthetic techniques.
Carroll
Ian R
IR
Veterans Affairs, Palo Alto Health Care System, and Stanford University Department of Anesthesiology, 3801 Miranda Ave., Palo Alto, CA 94304, USA.
Angst
Martin S
MS
Clark
J David
JD
D000700:Analgesics / Q000627:therapeutic use; D000765:Anesthesia, Conduction; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced; D009293:Opioid-Related Disorders / Q000150:complications*; D010146:Pain / Q000517:prevention & control*; D019990:Perioperative Care
D000700:Analgesics