WHAT IS KNOWN AND OBJECTIVE: The 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 DESCRIPTION: We 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 CONCLUSION: Ketamine 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.
- Analgesics, Opioid/therapeutic use
- Heroin/adverse effects
- Hyperalgesia/prevention & control
- Ketamine/therapeutic use
- Methadone/therapeutic use
- Middle Aged
- Opioid-Related Disorders/complications
- Pain Management/methods
- Pain, Postoperative/drug therapy
- Perioperative Care
- Postoperative Period