Opioid Free Anesthesia For A Patient With History Of Intravenous Drug Abuse

Proposal Number:

MCC-7148 

Proposal Type:

Medically Challenging Case Report Poster 

Author:

Benjamin Hancock  
Icahn School of Medicine at Mount Sinai

Co-Author:

Garrett Burnett  
Icahn School of Medicine at Mount Sinai

Abstract:

A 32 year-old male in recovery from IV opiate abuse and cleft lip/palate status post previous corrective surgery was schedule for palatoplasty with cleft palate bone graft and removal of impacted tooth. Given his prior history of opiate abuse, the patient requested an anesthetic devoid of any opiate. After discussion with the patient of the risks, including intra-operative hemodynamic instability and post operative pain, a multimodal approach of local anesthetic infiltration by the surgeon, IV acetaminophen, midazolam, ketorolac, ketamine, propofol and lidocaine infusions, inhaled sevoflurane, and intermittent esmolol bolus was utilized. The anesthetic was well tolerated, with heart rates ranging from 60-90s and mean arterial pressures ranging from 70s to 100s. Post operative pain in the recovery room and at discharge was managed with oral acetaminophen and ibuprofen.

Intraoperative lidocaine infusion has been shown to reduce postoperative opioid use and improve pain (1). Lidocaine has also been shown to attenuate the stress response associated with surgical stimulation (2). For these reasons, lidocaine infusion may be an underutilized anesthetic and useful adjuvant to the opiate free anesthetic plan.

Professional Category:

Resident/Trainee

Keywords:

General
Pain Management

Enter up to two references.

  Reference
1. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials Vigneault, L., Turgeon, A.F., Côté, D. et al. Can J Anesth/J Can Anesth (2011) 58: 22. https://doi.org/10.1007/s12630-010-9407-0
2. A randomized study of the effects of perioperative i.v. lidocaine on hemodynamic and hormonal responses for cesarean section El-Tahan, M.R., Warda, O.M., Diab, D.G. et al. J Anesth (2009) 23: 215. https://doi.org/10.1007/s00540-009-0738-3