Chern Sy-Yeu S, Isserman Rebecca, Chen Linda, Ashburn Michael, Liu Renyu
Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Hospital of University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
J Anesth Clin Res. 2013 Oct 30;3(250). doi: 10.4172/2155-6148.1000250.
Here we present a patient with a Type I Chiari malformation who was receiving buprenorphine for chronic pain who underwent two separate urogynecologic procedures for removal of vaginal mesh with two different pain management regimens. For the first procedure at an outside hospital, the patient's usual dose of buprenorphine (8 mg sublingual every 8 hours) was continued up through her surgery and then a full opioid receptor agonist was used for postoperative pain management. The patient complained that this resulted in very poor pain control for her in the postoperative period. Prior to her second procedure, which was performed at our institution, buprenorphine was switched to a full opioid agonist (oral hydromorphone 4 mg every 4 to 6 hours, maximum 20 mg per day) for 5 days prior to surgery; postoperative pain was managed with full opioid receptor agonists. The patient again reported suboptimal pain control in spite of substantially increased doses of opioids. This case report highlights the difficulty of perioperative pain management for patients on chronic buprenorphine and emphasizes the need for additional investigation.
在此，我们介绍一位患有I型Chiari畸形的患者，该患者因慢性疼痛正在接受丁丙诺啡治疗，其接受了两次不同的泌尿妇科手术以取出阴道网片，采用了两种不同的疼痛管理方案。在外部医院进行的第一次手术中，患者常规剂量的丁丙诺啡（每8小时舌下含服8毫克）在手术全程持续使用，然后使用一种完全阿片受体激动剂进行术后疼痛管理。患者抱怨这导致她术后疼痛控制非常差。在我们机构进行的第二次手术前，在手术前5天将丁丙诺啡换为完全阿片激动剂（口服氢吗啡酮，每4至6小时4毫克，每日最大剂量20毫克）；术后疼痛用完全阿片受体激动剂进行管理。尽管阿片类药物剂量大幅增加，患者再次报告疼痛控制不理想。本病例报告突出了慢性丁丙诺啡治疗患者围手术期疼痛管理的困难，并强调了进一步研究的必要性。
