{
  "abstract": "Background and Aims Postoperative management in multi-pathological patients, especially those with a history of intravenous drug addiction and chronic pain, can be challenging in our routine clinical practice. Multimodal and individualised analgesia is essential to prevent opioid overdose-related, postoperative complications and improve prognosis.Results A 39-year-old man, with a history of intravenous drug addiction, on treatment with oral methadone 40 mg/24 h, scheduled for 6-level arthrodesis (T2-T9) and debridement due to spondylodiscitis. Before surgery, NSAIDs (dexketoprofen 50 mg), paracetamol (1 g) and gabapentinoids (300 mg) were administered, in addition to the usual dose of methadone (40 mg) and benzodiazepines (diazepam 5 mg). Intraoperatively, a multimodal approach was used including intrathecal morphine (300 mcg), dexmedetomidine bolus (0.5 mg/kg), ketamine (0.5 mg/kg), lidocaine (1 mg/kg) and dexamethasone (8 mg) before induction and surgical incision, followed by ketamine (0.2 mg/kg/h) and remifentanil (TCI 1 ng/mL) infusions. In the immediate postoperative period, he presented minimal pain (maximum VAS 1/10 at rest) and patient-controlled analgesia (PCA) was started with morphine (1 mg/bolus: administered 21/attempted 32 in the first 24 hours), in addition to conventional pharmacotherapy (dexketoprofen 50 mg/8 h and paracetamol 1 g/6 h). He was discharged 24 h after admission to the post-surgical critical care unit, with optimal pain control (maximum VAS 1/10 at rest), no opioid-related problems and no significant clinical incidents.Conclusions This case highlights the efficacy and efficiency of a multimodal strategy in the postoperative management of complex opioid-tolerant patients. By addressing multiple targets, such as central nociceptive modulation with intrathecal morphine (mu receptor agonist), ketamine (non-competitive NMDA receptor antagonist) and peripheral with NSAIDs, lidocaine (voltage-dependent sodium channel blocker), gabapentinoids (prevention of central sensitisation with calcium channel modulation) and dexamethasone (inflammation), adequate pain control and early recovery were achieved. It is essential to adapt anaesthetic management according to the characteristics of the patient and the surgery performed, in order to allow individualised pain control that reduces morbidity in surgical critical care units and optimises hospital resources.Abstract EP048 Figure 16-level arthrodesis (T2-T9)",
  "authors": [
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Irene Zaragoza Garcia"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Esther Vila Barriuso"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Adrian Fernandez Castiñeira"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Anna Recasens Garcia"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Irina Adalid Hernandez"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Angie Catherine Carpintero Cruz"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Miguel Garcia Olivera"
    },
    {
      "affiliations": [
        "Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Eliana Ximena Lopez Arguelles"
    }
  ],
  "title": "EP048 Acute postoperative pain control in spine surgery in patients with chronic opioid use",
  "uid": "fa4ef50b-a0a1-584a-9a57-73da6df7b7d8"
}