title: Perioperative analgesia and challenges in the drug-addicted and drug-dependent patient.
abstract: The epidemic use of illicit drugs has led to an increasing number of patients with drug addiction and dependence presenting for perioperative care. There are a wide variety of drugs commonly abused including opioids, such as heroin and prescription drugs; stimulants, such as amphetamine and cocaine; depressant drugs, such as alprazolam and diazepam; and hallucinogens, such as lysergic acid diethylamide, phencyclidine, and marijuana. Treatment of opioid dependence by office-based buprenorphine and methadone maintenance programs has expanded opportunities for therapy. Treatment of these patients in the perioperative period is challenging. In addition to pain control, management of anxiety, psychological states, and hemodynamic control are the factors to be considered to provide optimum treatment. Although opioids are the mainstay for the control of acute pain, other therapeutic options include alternative routes of administration of local anesthetic, ketamine infusion, and the use of regional anesthesia. We discuss optimum perioperative management, the role of perioperative urine testing, and special considerations in patients on methadone and buprenorphine.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT 06520, USA. Electronic address: Nalini.vadivelu@yale.edu.
authors.forename: Nalini
authors.initials: N
authors.lastname: Vadivelu
authors.affiliation: Department of Anesthesia and Intensive Care, Government Medical College & Hospital, Sector 32, Chandigarh 160030, India. Electronic address: drsmitra12@yahoo.com.
authors.forename: Sukanya
authors.initials: S
authors.lastname: Mitra
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: alankaye44@hotmail.com.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, 75 Francis St, Boston, MA 02115, USA. Electronic address: rurman@partners.org.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000777:Anesthetics / Q000008:administration & dosage*; D006801:Humans; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation; D019990:Perioperative Care / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications* / Q000534:rehabilitation
chemical_list: D000701:Analgesics, Opioid; D000777:Anesthetics
keywords: buprenorphine; drug addiction; drug dependence; methadone maintenance; opioid dependence; perioperative analgesia; sub-anesthetic ketamine infusion