Role of Ketamine and Opioid Rotation in the Management of Opioid Induced Hyperalgesia in a Patient With Acute Promyelocytic Leukemia

Abstract

Introduction Opioid analgesics are commonly used to manage moderate to severe cancer related pain. However long-term use of opioids has been known to lead to several unintended side effects, including opioid induced hyperalgesia (OIH) which is defined as the paradoxical increase in pain sensitization to pain stimulus following opioid exposure. Currently there are limited reports on the association between patients with cancer and OIH, and this phenomenon is rarely described in patients with leukemia or lymphoma. Here we report a patient with acute promyelocytic leukemia who developed opioid induced hyperalgesia following rapid escalation of opioids. Case report A 36-year-old female being treated for acute promyelocytic leukemia presented with rapidly worsening acute on chronic hip pain requiring increasing opioid requriements. Given the rapid escalation of opioid dose with minimal response and physical exam findings consistent with allodynia/hyperalgesia a diagnosis of opioid induced hyperalgesia was made. Management and outcome Following recognition of opioid induced hyperalgesia, the patient was managed with opioid rotation and ketamine, which resulted in prompt alleviation of pain. Discussion Opioid induced hyperalgesia is likely an underrecognized phenomenon in patients with cancer-related pain. A high index of clinical suspicion are necessary for diagnosis and proper management of this disease entity.

Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial

“…[18][19][20] In addition, there are many adverse reactions caused by general anesthetics, especially nausea and vomiting, constipation, hypotension, respiratory depression and hyperalgesia caused by opioids. [21][22][23][24] There are few data currently available from published studies that compared peripheral nerve blocks with general anesthesia for patients who underwent DF surgery. To compare the effects of the above two different anesthesia methods on the perioperative physiological function of patients, this study intends to prospectively analyze the impact of general anesthesia versus peripheral nerve block anesthesia on perioperative hemodynamic changes and the prognosis of diabetic patients to evaluate the beneficial and detrimental effects of the two different anesthesia methods on patients.…”

Efektivitas Rotasi Opioid Dibandingkan Kombinasi Opioid untuk Mengobati Nyeri Kanker: Laporan Kasus Berbasis Bukti

“…13 Efek samping yang paling sering ditemukan pada penggunaan kronis opioid adalah hiperalgesia terinduksi opioid. 14 Efek samping lainnya yang dapat terjadi yaitu sedation berlebihan, depresi napas, hiperkapnia, perburukan tekanan intrakranial, nausea, dan vomitus. 15 Hanya 30% nyeri kanker dan diberi opioid kuat masih belum mengalami perbaikan, timbul efek samping opioid, atau terjadi keduanya.…”