Abstract
Purpose
We retrospectively studied perioperative management of patients receiving opioid treatment for cancer pain to facilitate establishing a standard policy for our institute.
Methods
Subjects were patients who had been administered strong opioids for cancer pain and had undergone surgery with general anesthesia. We divided the patients into groups C and D. Group C was comprised of patients who had been administered their baseline opioids continuously during the perioperative period, and group D of those who had discontinued baseline opioid use during this period.
Results
We identified 70 evaluable patients, 36 in group C and 34 in group D. The intraoperative anesthesia courses were similar, being uneventful, in all cases. With respect to postoperative adverse effects within 24 h after awakening from anesthesia, severe adverse effects (additional administration of more than four analgesics and intense agitation) were significantly more frequent in group D than in group C (12 vs 1, respectively. p = 0.004). Univariate analysis revealed that baseline opioid discontinuation was the only factor associated with severe adverse effects [odds ratio 12.6, 95% confidence interval (1.49–105.8), p = 0.01].
Conclusion
Discontinuation of baseline opioid increased adverse effects in the early postoperative period, which were attributed to exacerbation of early postoperative pain.
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References
Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology. 2004;101(1):212–27.
Rozen D, Grass GW. Perioperative and intraoperative pain and anesthetic care of the chronic pain and cancer pain patient receiving chronic opioid therapy. Pain Pract. 2005;5(1):18–32.
Richebe P, Beaulieu P. Perioperative pain management in the patient treated with opioids: continuing professional development. Can J Anaesth. 2009;56:969–81.
Alsahaf MH, Stockwell M. Respiratory failure due to the combined effects of transdermal fentanyl and epidural bupivacaine/diamorphine following radical nephrectomy. J Pain Symptom Manag. 2000;20:210–3.
Bailey PL, Egan TD, Stanley TH. Intravenous opioid anesthetics. In: Miller RD, editor. Anesthesia, 5th ed. New York: Churchill Livingstone. 2000. p 330.
Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth. 2011;107:619–26.
Song CW, Chelstrom LM, Levitt SH, Haumschild DJ. Effects of temperature on blood circulation measured with the laser Doppler method. Int J Radiat Oncol Biol Phys. 1989;17:1041–7.
Takahashi R, Waseda Y, Nitta S. Perioperative management of the patients with cancer pain receiving fentanyl patch (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2008;57:886–8.
Hanks GW, Twycross RG, Lloyd JW. Unexpected complication of successful nerve block. Morphine induced respiratory depression precipitated by removal of severe pain. Anesthesia. 1981;36:37–9.
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Fujita, T., Iwade, M., Hamada, K. et al. Perioperative management of patients with cancer pain treated with opioids: a retrospective study. J Anesth 32, 585–591 (2018). https://doi.org/10.1007/s00540-018-2518-4
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DOI: https://doi.org/10.1007/s00540-018-2518-4