Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Stromer, W; Michaeli, K; Sandner-Kiesling, A.
Perioperative pain therapy in opioid abuse.
Eur J Anaesthesiol. 2013; 30(2):55-64
Doi: 10.1097/EJA.0b013e32835b822b
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- Co-Autor*innen der Med Uni Graz
- Michaeli Kristina Daniela
- Sandner-Kiesling Andreas
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- Abstract:
- Opioid addiction represents an exaggerated organic and psychological comorbidity and should be regarded as a high-risk problem. Particular features seen perioperatively are tolerance, hyperalgesia and higher analgesic requirement together with physical and psychological withdrawal symptoms. Adequate pain management should have a high priority even for these patients.This review deals with the specific problems of addiction or opioid tolerance in this vulnerable patient group in the perioperative period. In this group are opioid-tolerant chronic pain patients on long-term therapy, addicts with long-term substitution therapy, those currently addicted and those with a previous history of addiction, mainly to heroin. This article intends to simplify the management of drug-dependent patients and offers strategies for perioperative analgesia that include stabilisation of physical dependency by substitution with methadone or μ-agonists; avoidance of stress; use of regional techniques in combination with non-opioids or opioids with higher doses than those used in non-addicts; avoidance of inadequate analgesic dosing; effective use of the opioid-sparing effect of different co-analgesics; and psychological support wherever appropriate.Those caring for abstinent patients should note that an inadequate dosage of analgesics can potentially reactivate addiction. After successful withdrawal of opioids and prolonged abstinence, opioid therapy can result in an exaggerated response.
- Find related publications in this database (using NLM MeSH Indexing)
- Analgesics, Opioid - therapeutic use
- Humans -
- Pain, Postoperative - drug therapy
- Find related publications in this database (Keywords)
- addictive disease
- anaesthesia
- analgesia
- comorbidity
- opioid withdrawal syndrome
- perioperative analgesic concept