EVIDENCE-BASED ANALGESIA FOR OPIOID DEPENDENT PATIENTS UNDERGOING MAJOR SURGERY

There is a high prevalence of chronic pain in America that has resulted in the increased use of opioids for treatment. Healthcare providers are challenged with alleviating acute surgical pain in chronic opioid dependent patients undergoing major surgery. These challenges are due to physical dependence, opioid tolerance, and/or opioid induced hyperalgesia. Results of an integrative literature review indicate that current published practice recommendations (guidelines) are based primarily on secondary sources, case reports, and expert opinion. The medicinal therapies that were reviewed included multimodal analgesia (with and without ketamine), intravenous lidocaine, fentanyl challenge, and methadone. Of these, the evidence supports the use of ketamine when used as adjunctive therapy in a multimodal regimen, and the use of intravenous lidocaine for abdominal surgeries. Further research is recommended for medicinal modalities in alleviating acute surgical pain in chronic opioid dependent patients undergoing major surger