The epidural works, but the patient hurts! Acute pain management of the chronic pain patient.
Perioperative management of opioid-dependent patients can be a challenge to surgeons, anesthesiologists and pain specialist. Our case illustrates the consequences of poor management of this subset of patients. A 60-year-old male with history left renal mass was scheduled for a left open nephrectomy. Preoperative pain medications included fentanyl 50 mcg every 72 hours plus hydromorphone 4mg PO PRN for breakthrough pain. An epidural was placed for post-operative pain control, and opioids were discontinued during hospitalization. Forty-eight to seventy-two hours after surgery, the patient developed withdrawal symptoms. Home medications were restarted and symptoms resolved.
Grewal
P K
PK
University of Arkansas for Medical Sciences, USA.
Firnhaber-Burgos
Juan B
JB
D000208:Acute Disease; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002908:Chronic Disease; D003266:Continuity of Patient Care; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000701:Analgesics, Opioid; D004091:Hydromorphone; D005283:Fentanyl