Difference between revisions of "Opioid use disorder"
(Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = | specialty = | signs_symptoms = | diagnosis = | treatment = | image = | caption = }} Provide a brief summary of this comorbidity here. == Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. --> == === Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. --> === Patients with opioid...") |
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{{Infobox comorbidity | {{Infobox comorbidity | ||
| | | anesthetic_relevance = High | ||
| | | anesthetic_management = | ||
| specialty = | | specialty = Pain | ||
| signs_symptoms = | | signs_symptoms = | ||
| diagnosis = | | diagnosis = | ||
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Provide a brief summary of this comorbidity here. | Provide a brief summary of this comorbidity here. | ||
== | == Epidemiology == | ||
== | == Anesthetic implications == | ||
Patient's with opioid use disorder on maintenance therapy with Suboxone (buprenorphine-naloxone) or methadone are at high risk of inadequately controlled pain post-procedure 2/2 low dosing or slow titration. | |||
== Pathophysiology == | |||
Buprenorphine is a partial mu-opioid receptor agonist and kappa-opioid receptor. It is associated with less opioid-induced hyperalgesia compared to other opioids. | |||
== | == Anesthetic management == | ||
=== | === Preoperative optimization === | ||
The dose of suboxone has implications for the risk of opioid tolerance and increased post-operative pain. | |||
=== | Non-opioid agents such as Tylenol and gabapentin. Gabapentin has been shown to promote drug-abstinence in patient on outpatient methadone therapy.<ref>{{Cite journal|last=Compton|first=Peggy|last2=Kehoe|first2=Priscilla|last3=Sinha|first3=Karabi|last4=Torrington|first4=Matt A.|last5=Ling|first5=Walter|date=2010-06-01|title=Gabapentin improves cold-pressor pain responses in methadone-maintained patients|url=https://pubmed.ncbi.nlm.nih.gov/20163921/|journal=Drug and Alcohol Dependence|volume=109|issue=1-3|pages=213–219|doi=10.1016/j.drugalcdep.2010.01.006|issn=1879-0046|pmc=2875370|pmid=20163921}}</ref> A shared neuro-inflammatory and central sensitization process akin to that of neuropathic pain may explain the cross-benefit it has in patients with opioid-induced hyperalgesia. | ||
=== | === Intraoperative management === | ||
Regional anesthesia techniques | |||
Ketamine is a useful adjunct in | |||
== | === Postoperative management === | ||
Consider post-operative stay in the ICU for pain management and consultation of in-house pain service. Buprenorphine can be safely ordered at patient's reported dosing for post-operative pain management as it is unlikely to cause respiratory depression. | |||
== References == | == References == | ||
Compton P, Kehoe P, Sinha K, Torrington MA, Ling W. Gabapentin improves cold-pressor pain responses in methadone-maintained patients. Drug Alcohol Depend. 2010 Jun 1;109(1-3):213-9. doi: 10.1016/j.drugalcdep.2010.01.006. Epub 2010 Feb 16. PMID: 20163921; PMCID: PMC2875370. | |||
[[Category:Comorbidities]] | [[Category:Comorbidities]] | ||
Revision as of 15:38, 2 August 2022
| Anesthetic relevance |
High |
|---|---|
| Anesthetic management | |
| Specialty |
Pain |
| Signs and symptoms | |
| Diagnosis | |
| Treatment | |
| Article quality | |
| Editor rating | |
| User likes | 2 |
Provide a brief summary of this comorbidity here.
Epidemiology
Anesthetic implications
Patient's with opioid use disorder on maintenance therapy with Suboxone (buprenorphine-naloxone) or methadone are at high risk of inadequately controlled pain post-procedure 2/2 low dosing or slow titration.
Pathophysiology
Buprenorphine is a partial mu-opioid receptor agonist and kappa-opioid receptor. It is associated with less opioid-induced hyperalgesia compared to other opioids.
Anesthetic management
Preoperative optimization
The dose of suboxone has implications for the risk of opioid tolerance and increased post-operative pain.
Non-opioid agents such as Tylenol and gabapentin. Gabapentin has been shown to promote drug-abstinence in patient on outpatient methadone therapy.[1] A shared neuro-inflammatory and central sensitization process akin to that of neuropathic pain may explain the cross-benefit it has in patients with opioid-induced hyperalgesia.
Intraoperative management
Regional anesthesia techniques
Ketamine is a useful adjunct in
Postoperative management
Consider post-operative stay in the ICU for pain management and consultation of in-house pain service. Buprenorphine can be safely ordered at patient's reported dosing for post-operative pain management as it is unlikely to cause respiratory depression.
References
Compton P, Kehoe P, Sinha K, Torrington MA, Ling W. Gabapentin improves cold-pressor pain responses in methadone-maintained patients. Drug Alcohol Depend. 2010 Jun 1;109(1-3):213-9. doi: 10.1016/j.drugalcdep.2010.01.006. Epub 2010 Feb 16. PMID: 20163921; PMCID: PMC2875370.
- ↑ Compton, Peggy; Kehoe, Priscilla; Sinha, Karabi; Torrington, Matt A.; Ling, Walter (2010-06-01). "Gabapentin improves cold-pressor pain responses in methadone-maintained patients". Drug and Alcohol Dependence. 109 (1–3): 213–219. doi:10.1016/j.drugalcdep.2010.01.006. ISSN 1879-0046. PMC 2875370. PMID 20163921.