[Acute opiate tolerance and postoperative hyperalgesia after a brief infusion of remifentanil managed with multimodal analgesia].
Postoperative analgesia may be complicated by the occurrence of acute opiate tolerance and hyperalgesia. We present the case of a patient who underwent gynecological surgery that was complicated by intense pain in the immediate postoperative period. The pain was attributed to the development of acute opiate tolerance caused by the brief infusion of a high dose of remifentanil. The opiate tolerance was complicated by tactile hyperalgesia at the site of the surgical wound. Pain management with the usual dose of nonsteroidal anti-inflammatory drugs associated with a high dose of morphine (50 mg administered in less than 2 hours) produced no analgesic or adverse effects. The pain was finally brought under control by epidural perfusion of ropivacaine and fentanyl and subsequently maintained with multimodal analgesia.
Cortiñas Sáenz
M
M
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Granada. stl967523977@wanadoo.es
Gerónimo Pardo
M
M
Cortiñas Sáenz
M L
ML
Hernández Vallecillo
M T
MT
Ibarra Martí
M L
ML
Mateo Cerdán
C M
CM
D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000291:Adnexal Diseases / Q000601:surgery; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D015360:Analgesia, Epidural; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D004351:Drug Resistance; D004361:Drug Tolerance; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced* / Q000188:drug therapy; D007044:Hysterectomy; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000139:chemically induced* / Q000188:drug therapy; D010880:Piperidines / Q000009:adverse effects*; D000077208:Remifentanil; D000077212:Ropivacaine
D000577:Amides; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010880:Piperidines; D000082:Acetaminophen; D009020:Morphine; D000077212:Ropivacaine; D000077208:Remifentanil; D005283:Fentanyl; D020910:Ketorolac