Perioperative management of the chronic pain patient.
The chronic pain patient has certain distinctive features important for her/his perioperative management. Altered opioid sensitivity and behavior are the major points to be considered. The pre-anesthetic visit should therefore include questions regarding chronic pain and regular use of analgesics and coanalgesics, among others. Although a number of characteristics-including increased opioid demand, underreporting of pain, and non-compliance--are known, only a few specific recommendations are available, viz. adequate increase of opioid dose for analgesia, continuation of pre-operative opioids and coanalgesics to prevent withdrawal, and intensive education to strengthen the patient's coping potential. No differences between specific techniques for post-operative analgesia (e.g. systemic, patient-controlled or regional analgesia) have been shown so far.
Kopf
Andreas
A
Department of Anesthesiology and Intensive Care Medicine, Charité--Campus Benjamin Franklin Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany. andreas.kopf@charite.de
Banzhaf
Anne
A
Stein
Christoph
C
D000698:Analgesia / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods; D002908:Chronic Disease; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D019990:Perioperative Care / Q000379:methods*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid