Philip G Boysen1,2, Marisa M Pappas1, Bryan Evans1. 1. Department of Anesthesiology, Ochsner Clinic Foundation, New Orleans, LA. 2. The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Abstract
BACKGROUND: The epidemic of opioid abuse is increasing, and the number of deaths secondary to opioid overdose is also increasing. Recent attention has focused on opioid prescribing and management of chronic pain. However, opioid use in perioperative and periprocedural patients, whether they have chronic pain or exhibit new persistent opioid abuse after a procedure, has received little attention. METHODS: We present an evidence-based technique that combines subanesthetic infusions of lidocaine and dexmedetomidine supplemented with other intravenous agents and a low dose of inhaled anesthetic. RESULTS: Based on evidence of drug action and interaction, an opioid-free anesthetic can be delivered successfully. We present the cases of 2 patients in whom the opioid-free anesthetic technique was used with a successful outcome, adequate pain management, and avoidance of opioid drugs. CONCLUSION: This anesthetic prescription can be useful for opioid-naïve patients as well as for patients with chronic pain that is managed with opioids.
BACKGROUND: The epidemic of opioid abuse is increasing, and the number of deaths secondary to opioid overdose is also increasing. Recent attention has focused on opioid prescribing and management of chronic pain. However, opioid use in perioperative and periprocedural patients, whether they have chronic pain or exhibit new persistent opioid abuse after a procedure, has received little attention. METHODS: We present an evidence-based technique that combines subanesthetic infusions of lidocaine and dexmedetomidine supplemented with other intravenous agents and a low dose of inhaled anesthetic. RESULTS: Based on evidence of drug action and interaction, an opioid-free anesthetic can be delivered successfully. We present the cases of 2 patients in whom the opioid-free anesthetic technique was used with a successful outcome, adequate pain management, and avoidance of opioid drugs. CONCLUSION: This anesthetic prescription can be useful for opioid-naïve patients as well as for patients with chronic pain that is managed with opioids.
Entities:
Keywords:
Anesthesia; balanced anesthesia; dexmedetomidine; lidocaine; opioid-related disorders; perioperative care
Authors: Louise Vigneault; Alexis F Turgeon; Dany Côté; François Lauzier; Ryan Zarychanski; Lynne Moore; Lauralyn A McIntyre; Pierre C Nicole; Dean A Fergusson Journal: Can J Anaesth Date: 2011-01 Impact factor: 5.063
Authors: Guy L Weinberg; Guido Di Gregorio; Richard Ripper; Kemba Kelly; Malek Massad; Lucas Edelman; David Schwartz; Nirali Shah; Sophie Zheng; Douglas L Feinstein Journal: Anesthesiology Date: 2008-05 Impact factor: 7.892