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Management of Perioperative Pain in Patients Chronically Consuming Opioids
  1. Ian R. Carroll, M.D.,
  2. Martin S. Angst, M.D. and
  3. David J. Clark, M.D., Ph.D
  1. From Veterans Affairs, Palo Alto Health Care System, and Stanford University Department of Anesthesiology, Palo Alto, California.
  1. Reprint requests: J. David Clark, M.D., Ph.D., VAPAHCS Anesthesiology, 112A, 3801 Miranda Ave., Palo Alto, CA 94304. E-mail: djclark{at}


Background The prevalence of licit and illicit opioid use is growing, and a greater percentage of chronically opioid-consuming patients are presenting for surgery. These patients can be expected to experience increased postoperative pain, greater postoperative opioid consumption, and prolonged use of healthcare resources for managing their pain.

Methods Achieving adequate pain control in these patients can be challenging because commonly used strategies for alleviating postoperative pain may have diminished effectiveness. We explore the prevalence and characteristics of opioid use in the United States and discuss its impact on the perioperative management of pain. We examine mechanistically why adequate perioperative pain control in chronically opioid-consuming patients may be difficult.

Conclusions We present strategies for providing adequate analgesia to these patients that include the optimal use of opioids, adjuvant medications, and regional anesthetic techniques.

  • Pain
  • Opioids
  • Tolerance
  • Hyperalgesia
  • Addiction
  • Epidural

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