Institute of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
J Clin Pharm Ther. 2019 Jun;44(3):397-399. doi: 10.1111/jcpt.12798. Epub 2019 Jan 12.
The exponential increase in chronic opioid consumers resulted in more challenges regarding post-operative pain management. Considering the usual hyperalgesic response to pain and the increased opioid-tolerance, a multidrug approach should be desirable.
We described the strategy in pain management of a patient receiving methadone maintenance treatment, who underwent surgery associated with moderate post-operative pain. The combination of balanced general anaesthesia and intraoperative continuous low-dose infusion of ketamine assured an appropriate control of post-operative pain without increasing opioid consumption. Besides, it was not associated with psychomimetic effects.
Ketamine can effectively reduce opioid requirements in chronic opioid users on methadone maintenance therapy and should therefore be considered promptly as part of a multimodal perioperative analgesia management in this category of patients.
慢性阿片类药物使用者的指数增长导致术后疼痛管理面临更多挑战。考虑到对疼痛的通常痛觉过敏反应和增加的阿片类药物耐受性，应该采用多药物方法。
我们描述了一名接受美沙酮维持治疗的患者的疼痛管理策略，该患者接受了与中度术后疼痛相关的手术。平衡全身麻醉和术中持续输注小剂量氯胺酮的组合确保了适当的术后疼痛控制，而不会增加阿片类药物的消耗。此外，它与精神拟态作用无关。
氯胺酮可以有效减少美沙酮维持治疗的慢性阿片类药物使用者的阿片类药物需求，因此应作为此类患者多模式围手术期镇痛管理的一部分迅速考虑。
