<p>Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse</p>

Abstract

The opioid crisis in the United States has been pandemic. As such, anesthesia providers are frequently faced with patients who have a history of opioid abuse or are currently receiving chronic therapy for such disorders. The chronic administration of medications such as buprenorphine-naloxone can impact the choice of perioperative anesthesia and pain control. Furthermore, the postoperative administration of opioids may lead to relapse in patients with a history of opioid abuse. We present a 26-year-old male with a history of opioid abuse on maintenance therapy with buprenorphine-naloxone, who presented for median sternotomy, cardiopulmonary bypass, and pulmonary valve replacement. The perioperative implications of buprenorphine-naloxone and implementation of multimodal analgesia are discussed, along with options to decrease or eliminate the perioperative use of opioids.

Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review

“…Effective analgesia is the cornerstone of any postoperative course and is crucial to ensuring a patient has a timely discharge while minimising the risk of postoperative complications. There has been a general shift to reducing opioid use due to their negative effects on the GI system and the opioid pandemic in the United States [ 98 , 99 ]. Opioids are known to cause postoperative nausea and vomiting, both of which are associated with delaying oral consumption [ 100 ].…”

Post-Operative Management in Patients with Permanent Pacemakers Who Underwent Sternotomy e.c. Mediastinitis Complicated from Submandibular Absces in Intensive Care Unit: A Case Report

“…Doctors often advise using a multimodal analgesia approach in this population of patients who have had sternotomies to minimize or eliminate the need for opioid pain relief. Various types of analgesics can manage postoperative pain, including acetaminophen/paracetamol, gabapentanoid drugs, dexmedetomidine, nonsteroidal anti-inflammatory 819 agents, and ketamine 14.…”