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
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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
Topics
- Specific Pain Conditions/Pain in Specific Populations: Cancer Pain & Palliative Care