title: Opioid-free balanced anesthesia for cervical ganglionectomy subsequent to recent ultra rapid opioid detoxification.
abstract: OBJECTIVE
  To perform an opioid-free, balanced anesthetic for an Active Duty soldier undergoing cervical ganglionectomy for intractable occipital neuralgia 7 days after ultra rapid opioid detoxification (UROD) under general anesthesia.
  
  
  METHODS
  Opioids have been a mainstay for both intraoperative and postoperative analgesia. With the emergence of newer non-opioid analgesics and the practice of the multimodal analgesia, opioid therapy will be complimented and, in some cases, replaced by these newer agents. The increasing knowledge in the literature of both pain mechanisms and chronic pain treatment can present anesthesiologists with a challenge when faced with opioid-tolerant patients in the acute perioperative setting. With an increased focus on adequate pain control among health care regulatory agencies, we may expect to see a growing number of patients who desire weaning from chronic opioid therapy. There have been many weaning protocols proposed in the literature, with UROD under general anesthesia being one of them. We report a case of successful non-opioid analgesia in a patient that presented for a cervical ganglionectomy 7 days after UROD.
  
  
  CONCLUSIONS
  This patient successfully completed a perioperative and postoperative course using ketamine and dexmedetomidine infusions, in addition to other non-opioid adjuncts. The patient returned to her Active Duty station, with increased functional capacity and remains opioid-free.
authors.affiliation: Anesthesia and Operative Services, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW WA, DC 20307, USA. anthonyplunkett@comcast.net
authors.forename: Anthony
authors.initials: A
authors.lastname: Plunkett
authors.forename: Michael
authors.initials: M
authors.lastname: Fahlgren
authors.forename: Brian
authors.initials: B
authors.lastname: McLean
authors.forename: Derick
authors.initials: D
authors.lastname: Mundey
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D019162:Anesthetics, Combined / Q000494:pharmacology* / Q000627:therapeutic use; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005727:Ganglia, Spinal / Q000503:physiopathology / Q000601:surgery*; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D008658:Inactivation, Metabolic / Q000502:physiology; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods; D008889:Military Personnel; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D009293:Opioid-Related Disorders / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D011957:Receptors, Opioid / Q000187:drug effects / Q000378:metabolism; D013127:Spinal Nerves / Q000503:physiopathology / Q000601:surgery; D013375:Substance Withdrawal Syndrome / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000778:Anesthetics, Dissociative; D018685:Anesthetics, Inhalation; D011957:Receptors, Opioid; D020927:Dexmedetomidine; D007649:Ketamine; D007530:Isoflurane