Silviu Brill1, Yehuda Ginosar, Elyad M Davidson. 1. Sheba Medical Center, Department of Anesthesia and Intensive Care, Tel Hashomer, and Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. silviu.brill@sheba.health.gov.il
Abstract
PURPOSE OF REVIEW: In this article, we discuss the perioperative anesthesia and pain management of patients with chronic pain receiving chronic opioid administration. In our practice we may expect to be confronted with opioid-dependent patients in routine anesthesia practice and should acquire specific knowledge and skills to effectively manage the perioperative and acute pain management issues that arise. RECENT FINDINGS: The number of patients treated chronically with opioids has increased steadily over the past decade; currently about 10% of all chronic-pain patients are treated with opioids. As these patients are no longer confined to terminally ill cancer patients, growing numbers of these patients are facing surgical interventions. SUMMARY: In our clinical practice, we should employ multimodal pain management therapy by using an around-the-clock regimen of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, acetaminophen, and regional blockade. Dosing regimens should be individualized to optimize efficacy while minimizing the risk of adverse events.
PURPOSE OF REVIEW: In this article, we discuss the perioperative anesthesia and pain management of patients with chronic pain receiving chronic opioid administration. In our practice we may expect to be confronted with opioid-dependent patients in routine anesthesia practice and should acquire specific knowledge and skills to effectively manage the perioperative and acute pain management issues that arise. RECENT FINDINGS: The number of patients treated chronically with opioids has increased steadily over the past decade; currently about 10% of all chronic-painpatients are treated with opioids. As these patients are no longer confined to terminally ill cancerpatients, growing numbers of these patients are facing surgical interventions. SUMMARY: In our clinical practice, we should employ multimodal pain management therapy by using an around-the-clock regimen of nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, acetaminophen, and regional blockade. Dosing regimens should be individualized to optimize efficacy while minimizing the risk of adverse events.
Authors: Joseph P Cravero; Rita Agarwal; Charles Berde; Patrick Birmingham; Charles J Coté; Jeffrey Galinkin; Lisa Isaac; Sabine Kost-Byerly; David Krodel; Lynne Maxwell; Terri Voepel-Lewis; Navil Sethna; Robert Wilder Journal: Paediatr Anaesth Date: 2019-06-11 Impact factor: 2.556