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Case Reports
The epidural works, but the patient hurts! Acute pain management of the chronic pain patient.
- P K Grewal and Juan B Firnhaber-Burgos.
- University of Arkansas for Medical Sciences, USA.
- J Ark Med Soc. 2009 Aug 1;106(2):43-5.
AbstractPerioperative management of opioid-dependent patients can be a challenge to surgeons, anesthesiologists and pain specialist. Our case illustrates the consequences of poor management of this subset of patients. A 60-year-old male with history left renal mass was scheduled for a left open nephrectomy. Preoperative pain medications included fentanyl 50 mcg every 72 hours plus hydromorphone 4mg PO PRN for breakthrough pain. An epidural was placed for post-operative pain control, and opioids were discontinued during hospitalization. Forty-eight to seventy-two hours after surgery, the patient developed withdrawal symptoms. Home medications were restarted and symptoms resolved.
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