title: Perioperative management of the opioid tolerant patient for orthopedic surgery.
abstract: The prevalence of opioid use in the North America and some countries of the European Union has resulted in an increase in the number of patients who may exhibit opioid tolerance when requiring postoperative pain management. The approach to postoperative pain control in these patients is different from the strategies used in opioid-naïve patients. Better understanding of the cellular mechanisms of opioid tolerance in animals has resulted in the transfer of these concepts from the basic research to the clinical arena. This article presents new developments in opioid tolerance and how this knowledge can be applied to clinical practice.
authors.affiliation: University at Buffalo Department of Anesthesiology, 252 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Marchyarn
authors.initials: M
authors.lastname: Mahathanaruk
authors.affiliation: University at Buffalo Department of Anesthesiology, 252 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: James
authors.initials: J
authors.lastname: Hitt
authors.affiliation: University at Buffalo Department of Anesthesiology, 252 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA; Division of Pain Medicine, Department of Anesthesiology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. Electronic address: oscar.deleon@roswellpark.org.
authors.forename: Oscar A
authors.initials: OA
authors.lastname: de LeonCasasola
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004361:Drug Tolerance; D006801:Humans; D009293:Opioid-Related Disorders / Q000188:drug therapy; D019637:Orthopedic Procedures / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care / Q000379:methods*; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors
chemical_list: D000701:Analgesics, Opioid; D016194:Receptors, N-Methyl-D-Aspartate
keywords: Cellular mechanisms; Ketamine; Opioid tolerance; Opioids; Postoperative pain