Perioperative pain management in the patient treated with opioids: continuing professional development.
OBJECTIVE
The objective of this continuing professional development module is to describe the perioperative anesthesia and pain management of patients taking opioids because of chronic pain or drug addiction.


RESULTS
The number of patients under opioid treatment is increasing. Pain management is problematic in these patients, because regular opioid intake is associated with mechanisms of tolerance and dependence. More recently, opioid-induced hyperalgesia phenomena have been brought to light. As a rule, the usual opioid dose should be administered with the appropriate conversions, and additional requirements should be anticipated because of the surgical procedure. Local and regional anesthesia, and multimodal analgesia are indicated whenever possible. For the patient addicted to heroin or other opioids, the perioperative period is not a suitable time to initiate weaning.


CONCLUSIONS
The physiological and pharmacological changes caused by chronic opioid intake must be understood in order to provide optimal pain management with respect to each individual and the type of procedure.
Richebé
Philippe
P
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA 98195, USA. prichebe@u.washington.edu
Beaulieu
Pierre
P
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000758:Anesthesia / Q000379:methods; D000818:Animals; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010146:Pain / Q000188:drug therapy; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods
D000701:Analgesics, Opioid