• Roberta Barelli, Gloria Morelli Sbarra, Fabio Sbaraglia, Luca Zappia, and Marco Rossi.
• 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 1; 44 (3): 397-399.

What Is Known And ObjectiveThe 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.Case DescriptionWe 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.What Is New And ConclusionKetamine 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.© 2019 John Wiley & Sons Ltd.

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