Grewal P K, Firnhaber-Burgos Juan B
University of Arkansas for Medical Sciences, USA.
J Ark Med Soc. 2009 Aug;106(2):43-5.
Perioperative management of opioid-dependent patients can be a challenge to surgeons, anesthesiologists and pain specialist. Our case illustrates the consequences of poor management of this subset of patients. A 60-year-old male with history left renal mass was scheduled for a left open nephrectomy. Preoperative pain medications included fentanyl 50 mcg every 72 hours plus hydromorphone 4mg PO PRN for breakthrough pain. An epidural was placed for post-operative pain control, and opioids were discontinued during hospitalization. Forty-eight to seventy-two hours after surgery, the patient developed withdrawal symptoms. Home medications were restarted and symptoms resolved.
对阿片类药物依赖患者进行围手术期管理对外科医生、麻醉医生和疼痛专家来说可能是一项挑战。我们的病例说明了对这部分患者管理不善的后果。一名有左肾肿块病史的60岁男性计划接受左肾开放性切除术。术前止痛药物包括每72小时使用50微克芬太尼，以及按需口服4毫克氢吗啡酮用于控制爆发性疼痛。为控制术后疼痛置入了硬膜外导管，住院期间停用了阿片类药物。术后48至72小时，患者出现了戒断症状。重新开始服用家中的药物后症状得到缓解。
