Abstract
Perioperative opioid sparing techniques are paramount given the current opioid epidemic. A 54-year-old woman presented with medical history of acute cholecystitis for laparoscopic cholecystectomy. Our goal was adequate pain control while limiting opioid administration and opioid-related adverse effects. Pain was managed with preoperative acetaminophen, tramadol, and gabapentin, and intraoperatively with lidocaine, ketamine, and esmolol. Post-operative Visual Analog Score (VAS) was 0/10 immediately following surgery. Although her pain score peaked to 10/10 30 minutes post-operatively and she received 0.4 milligrams intravenous hydromorphone, her VAS then declined to 0 and remained so throughout her hospitalization without additional analgesics.
Highlights
AGONIST-ANTAGONIST OPIOIDS: Not recommended for severe, escalating pain
Manfredi PL, Borsook D, Chandler SW, et al: Intravenous methadone for cancer pain unrelieved by morphine and hydromorphone: clinical observations, Pain 70:99-101, 1997
The equianalgesic chart is helpful when switching from one drug to another, or switching from one route of administration to another
Summary
AGONIST-ANTAGONIST OPIOIDS: Not recommended for severe, escalating pain. If used in combination with mu agonists, may reverse analgesia and precipitate withdrawal in opioid-dependent patients. AGONIST-ANTAGONIST OPIOIDS: Not recommended for severe, escalating pain. If used in combination with mu agonists, may reverse analgesia and precipitate withdrawal in opioid-dependent patients. Not readily reversed by naloxone; NR for laboring patients.
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