Background & Aims

Perioperative anesthesia in opioid-tolerant patients presents unique challenges. Increasing prevalence due to chronic pain and prolonged opioid use. Requires tailored approaches for safe and effective care.
Aim of the study was to investigate the perioperative pain management of opioid-tolerant patients within the context of our institute’s clinical experience.
Objectives were:
1.To retrospectively analyze the perioperative pain management of opioid-tolerant patients.
2.To identify challenges and strategies in perioperative pain management of opioid-tolerant patients.

Methods

Study Population: Will consist of patients who underwent surgical procedures at dedicated cancer centre of Apex Institute of India, over the past 5 years. Patients included in the study will meet the following criteria:
1. Age 18 years or older.
2. Received opioid therapy for at least 30 days prior to surgery.
Data Collection:
Retrospective data collection will be conducted by reviewing electronic medical records from the Institutional database. The following data will be extracted:
1. Demographic information
2. Cancer diagnosis.
3. Preoperative assessment of pain and Opioid use history.
4. Surgical details
5. Anesthesia management: Anesthetic technique (e.g., general anesthesia, regional anesthesia and/or both), intraoperative opioid use, adjunctive analgesic modalities, perioperative monitoring
6. Perioperative outcomes: Postoperative pain scores, opioid consumption, incidence of opioid-related adverse events, length of hospital stay, 30-day postoperative complications.

Results

Total 5325 patient underwent surgery from January 2019 to December 2023. 2.57% (137) patients were on pre-operative opioids, 60.5% patients (83) were on strong opioids and 29.5% were on weak opioids. Amongst the location of malignancy 37.5% (49) patients belongs to head and neck malignancy.
During intra-operative period 53.8% patients received regional anaesthesia/analgesia (General anaesthesia with epidural/regional nerve block or combined spinal epidural) along with systemic opioids for their pain management.
NRS scores were indicative of effective pain management, with 94.2% of patients reporting NRS scores of less than 3 at discharge. This trend continued, with 98.2% of patients reporting NRS scores of less than 3 at the 2-week follow-up.
Postoperatively, 26.4% of patients were discharged on opioids, reflecting a substantial need for ongoing opioid therapy. However, over the following weeks, there was a gradual reduction in opioid use, with only 4% of patients (primarily inoperable cases) still on opioids postoperatively.

Conclusions

Our study demonstrates the importance of stratification on the basis of diagnosis and comorbidities,
Acute pain management in these patients is governed by the principles of provision of good analgesia and avoiding opioid withdrawal
Carefully planned and communicated discharge, with a weaning plan for additional opioids, is essential.

References

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Presenting Author

Brajesh Kumarratre

Poster Authors

brajesh kumar ratre

M. D.

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Seema Mishra

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Rakesh garg

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Nishkarsh Gupta

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Sachidanand Jee Bharti

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Vinod Kumar

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Dr. Prateek Maurya

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Sushma Bhatnagar

All India Institute of Medical Sciences, New Delhi, India

Lead Author

Topics

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