Abstract
Kratom is a herbal and natural dietary supplement from Southeast Asia that is gaining popularity in the United States. Its leaves contain multiple psychoactive chemicals that stimulate opioid, alpha-2, and serotonergic receptors. Kratom is used as a stimulant and in the treatment of anxiety, pain, and opioid withdrawal. In most states, kratom can be purchased legally and is sold at smoke shops, gas stations, and online. To date, only limited data is available on the impact of habitual kratom use on patients undergoing anesthesia. The following case report highlights multiple anesthetic challenges posed by a heavy kratom user.
Highlights
Kratom (Mitragyna speciosa) is a medicinal plant indigenous to Southeast Asia where it is used as a stimulant, analgesic, and in the treatment for opioid withdrawal and addiction [1-3]
We describe the anesthetic challenges encountered while caring for a heavy kratom user
It is sensible to advise patients to wean from kratom before surgery, guidance from an addiction specialist may be required given the possibility of severe withdrawal symptoms by heavy users
Summary
Kratom (Mitragyna speciosa) is a medicinal plant indigenous to Southeast Asia where it is used as a stimulant, analgesic, and in the treatment for opioid withdrawal and addiction [1-3]. Kratom is gaining popularity in the United States, where the estimated annual prevalence of use is 0.8% [4] It can be purchased from online retailers and is sold in smoke shops, gas stations, and supplement stores [2]. At 2 am on the morning after surgery, the patient’s thoracic pain had resolved but he complained of 10/10 jaw pain, prompting consultation with the chronic pain team His refractory pain was attributed to opioid resistance secondary to habitual kratom use. Hydrocodone-acetaminophen was held, and an IV hydromorphone patient-controlled analgesic pump (0.3 mg every 10 min) was initiated He was administered gabapentin 600 mg every night and ibuprofen 600 mg every 6 h. The patient and family felt his pain regimen was acceptable and his medical team deemed him suitable for discharge He was discharged home on the evening of POD2. His discharge analgesic regimen included ibuprofen 600 mg every 6 h as needed, gabapentin 600 mg at night, and 10 ml of hydrocodone-acetaminophen (7.5 mg/325 mg per 15 ml) every 4 h as needed for pain
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