Background & Aims

Opioid-Induced Hyperalgesia (OIH) is a type of secondary hyperalgesia associated with
prolonged exposure to opioids, resulting in paradoxical hypersensitivity to painful stimuli,
negatively impacting postoperative pain management. The present report aims to present a case of intraoperative anesthetic management in a patient on prolonged use of high doses of opioids.

Methods

The patient is a 44-year-old male, ASA II, obese, with a surgical history of cytoreductive
endoprosthesis due to myxoid chondrosarcoma in the left shoulder and subsequent follow-up
for a difficult-to-control mixed pain syndrome, using Methadone, Pregabalin, and
Amitriptyline. He was admitted for revision of the left humerus endoprosthesis with predictors
of a difficult airway. The intraoperative anesthetic management involved a multimodal strategy,
including the administration of dexamethasone, ondansetron, parecoxib, and dipyrone,
followed by pre-induction with dexmedetomidine, magnesium sulfate, and lidocaine, and
anesthesia induction with dextrocetamine, propofol, and rocuronium bromide.

Results

The patient progressed without the need for opioids and had a Visual Analogue Scale (VAS) score of 0 in the Post-anesthesia care unit (PACU).

Conclusions

Patients on chronic opioid use, such as Methadone, may be prone to OIH, emphasizing the importance of a strategic intraoperative anesthetic management to control hyperalgesia and postoperative pain without the need for additional opioid doses, as evidenced in this case.

References

1. Nafziger AN, Barkin RL. Opioid Therapy in Acute and Chronic Pain. J Clin Pharmacol. 2018 Sep:58(9):1111 1122;.
2. Velayudhan A, Bellingham G, Morley-Forster P. Opioid-induced hyperalgesia. Cont Educ Anaesth Crit Care Pain. 2014;14:125-129.
3. Fletcherand D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a
systematic review and a metaanalysis. Br J Anaesth. 2014;112(6):991-1004.
4. Vincent J, Philippe R, Guignard B, et al. Remifentanil-induced postoperative
hyperalgesia and its prevention with smalldose ketamine Anesthesiology. 2005;103(1):147-
155.

Presenting Author

Donn Thell Frewyd Sawntzy Junior

Poster Authors

mariam montejo marin montejo

resident

FCECON

Lead Author

Ivandete Coelho Pereira Pimentel

FCECON

Lead Author

RENATA DE ARAUJO FERNANDES

FCECON

Lead Author

CAROLINE OLINDA DE SOUZA PITOLI

FCECON

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care