• J Opioid Manag · Jan 2014

    Case Reports

    Perioperative dilemma: challenges of the management of a patient on mega doses of morphine and methadone.

    • Alan David Kaye, Aymen A Alian, Nalini Vadivelu, and Keun Sam Chung.
    • Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, Louisiana; Professor, Department of Pharmacology, Louisiana State University Health Science Center, New Orleans, Louisiana.
    • J Opioid Manag. 2014 Jan 1; 10 (1): 69-72.

    AbstractHigh doses of opioids are often needed in the management of cancer-related pain. A discussion of a patient's perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented. In the present case report, a patient on high doses of opioids, including morphine and methadone, with severe worsening back pain and a history of increasing opioid requirements for the last 2 months due to metastatic leiomyosarcoma to the femur, spine, and neck is described. Use of high dose opioids is associated with numerous challenges, including tolerance. The successful management of this patient was multimodal and included the use of potent analgesics, N-methyl-D-aspartatereceptor antagonists, and the α-2 agonist clonidine.

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