1. Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse
- Author
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Christopher McKee, Ana Gabriela Walch, Jena Bilinovic, Candice Burrier, Joseph D. Tobias, and Emmanuel Alalade
- Subjects
opioid tolerant patients ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Case Report ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Maintenance therapy ,030202 anesthesiology ,law ,Cardiopulmonary bypass ,Medicine ,media_common ,business.industry ,Addiction ,Opioid use disorder ,opioid use disorder ,Perioperative ,medicine.disease ,Cardiac surgery ,Anesthesiology and Pain Medicine ,Opioid ,Median sternotomy ,Anesthesia ,addiction ,business ,buprenorphine/naloxone ,030217 neurology & neurosurgery ,cardiac surgery ,medicine.drug - Abstract
The opioid crisis in the United States has been pandemic. As such, anesthesia providers are frequently faced with patients who have a history of opioid abuse or are currently receiving chronic therapy for such disorders. The chronic administration of medications such as buprenorphine-naloxone can impact the choice of perioperative anesthesia and pain control. Furthermore, the postoperative administration of opioids may lead to relapse in patients with a history of opioid abuse. We present a 26-year-old male with a history of opioid abuse on maintenance therapy with buprenorphine-naloxone, who presented for median sternotomy, cardiopulmonary bypass, and pulmonary valve replacement. The perioperative implications of buprenorphine-naloxone and implementation of multimodal analgesia are discussed, along with options to decrease or eliminate the perioperative use of opioids.
- Published
- 2020