Silvaggio Mathew P, Toman Melanie K, Peters Braden
Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Department of Anesthesia, Lakeridge Health, Oshawa, ON, Canada.
Oxf Med Case Reports. 2020 May 23;2020(4):omaa021. doi: 10.1093/omcr/omaa021. eCollection 2020 Apr.
Dexmedetomidine is a selective alpha 2 adrenergic agonist with known analgesic properties. Its perioperative use is associated with reduced pain scores and an opioid sparing effect. Management of postoperative pain in patients with a history of chronic opioid use can be challenging. Multimodal analgesia is recommended although the perioperative use of dexmedetomidine has not been extensively studied in this patient population. We present a case of intractable abdominal pain following open abdominoperineal resection in a patient with rectal cancer and a history of chronic opioid use. Following the introduction of dexmedetomidine into the patient's postoperative epidural solution, a noticeable decline in reported pain scores and use of breakthrough analgesia was appreciated. The analgesic efficacy of epidural dexmedetomidine in patients with a history of chronic opioid use warrants further study.
右美托咪定是一种具有已知镇痛特性的选择性α2肾上腺素能激动剂。其围手术期使用与疼痛评分降低和阿片类药物节省效应相关。有慢性阿片类药物使用史的患者术后疼痛管理可能具有挑战性。尽管右美托咪定在围手术期的使用尚未在该患者群体中进行广泛研究，但推荐采用多模式镇痛。我们报告一例直肠癌且有慢性阿片类药物使用史的患者在开放性腹会阴切除术后出现顽固性腹痛的病例。在将右美托咪定引入患者的术后硬膜外溶液后，报告的疼痛评分和突破性镇痛药物的使用明显下降。硬膜外右美托咪定在有慢性阿片类药物使用史患者中的镇痛效果值得进一步研究。
