Manejo perioperatorio de los pacientes tratados con opioides: desarrollo profesional continuo
Perioperative pain management in the patient treated with opioids: continuing professional development.
Richebé P, Beaulieu P.
Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.prichebe@u.washington.edu
Can J Anaesth. 2009 Dec;56(12):969-81. doi: 10.1007/s12630-009-9202-y. Epub 2009 Nov 3.
Abstract
PURPOSE: The objective of this continuing professional development module is to describe the perioperative anesthesia and pain management of patients taking opioids because of chronic pain or drug addiction. PRINCIPAL FINDINGS: The number of patients under opioid treatment is increasing. Pain management is problematic in these patients, because regular opioid intake is associated with mechanisms of tolerance and dependence. More recently, opioid-induced hyperalgesia phenomena have been brought to light. As a rule, the usual opioid dose should be administered with the appropriate conversions, and additional requirements should be anticipated because of the surgical procedure. Local and regional anesthesia, and multimodal analgesia are indicated whenever possible. For the patient addicted to heroin or other opioids, the perioperative period is not a suitable time to initiate weaning. CONCLUSION: The physiological and pharmacological changes caused by chronic opioid intake must be understood in order to provide optimal pain management with respect to each individual and the type of procedure.
http://link.springer.com/content/pdf/10.1007%2Fs12630-009-9202-y.pdf
Duración de la anestesia raquídea con bupivacaína en abusadores de opio con cirugía ortopédica de extremidades inferiores
Duration of spinal anesthesia with bupivacaine in chronic opium abusers undergoing lower extremity orthopedic surgery.
Dabbagh A, Dahi-Taleghani M, Elyasi H, Vosoughian M, Malek B, Rajaei S, Maftuh H.
Department of Anesthesiology, Taleghani Hospital, Faculty of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.alidabbagh@yahoo.com
Arch Iran Med. 2007 Jul;10(3):316-20.
Abstract
BACKGROUND: It has been demonstrated that chronic opium abusers have lower thresholds for pain. Spinal anesthesia is a common procedure in anesthesia, which is performed through administration of drugs (usually local anesthetics) in the intrathecal space, to produce temporary pain relief. The aim of this study was to determine whether chronic opium abuse could have any possible effect on the duration of spinal block by bupivacaine. METHODS: In a case-control study, 50 opium abusers and 50 nonabusers undergoing lower extremity orthopedic operations were selected from the patients admitted in Taleghani Hospital in Tehran for elective surgery. The study parameters were assimilated as much as possible, including the method of anesthesia. RESULTS: No statistically significant difference was noted between the two groups regarding the age, sex, and duration of surgery; while, the duration of sensory block was much shorter in the opium abusers (86.6+/-15.7 minutes) compared with the nonabusers (162+/-22.1 minutes) (P<0.0001). CONCLUSION: The study suggests a shortened duration of spinal block with bupivacaine in opium abusers. The results can propose a number of possible mechanisms including cross-tolerance mechanisms between local anesthetics and opioid compounds at the level of spinal neurons. Further molecular studies at the level of spine are suggested.
http://www.ams.ac.ir/AIM/NEWPUB/07/10/3/007.pdf
Abordaje perioperatorio de pacientes con abuso y tolerancia a los opioides
Perioperative approach to patients with opioid abuse an tolerance
Anesteshesiology News, June 2013
http://www.anesthesiologynews.com//download/Opioid_AN0613_WM.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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