Background and aims Background: Allergic reactions and anaphylaxis secondary to opioid allergy constitute 1.9% of all hypersensitivity reactions related to anaesthesia. It is recommended that patients known to be allergic to opioids should be managed with opioid free anaesthesia (OFA).
Aim of Study: To assess the efficiency of the Mullimix solution (50μg Dexmedetomidine, 500 mg lidocaine and 50 mg Ketamine in 100 ml N/S 0.9%), combined with continuous epidural injection of Ropivacaine0.2%, on haemodynamic parameters, pain control and patient satisfaction.
Methods We present a 73-year-old female patient, with a background of a previous reaction to opioids, undergoing a low anterior resection of the rectum. Before induction of general anaesthesia, an epidural catheter was placed, as per routine practice. After a loading dose of 50μg of dexmedetomidine intravenously (IV) over 10 minutes, ondansetron 4 mg and dexamethasone 8 mg, IV induction of anaesthesia was performed with a Mullimix bolus dose of 0.2 ml/kg, along with propofol (3 mg/kg) and rocuronium (0.9 mg/kg).A mixture of Desflurane/O2/air and a continuous IV infusion of Mullimix, at a rate of 0.2 ml/kg/h, were used for maintenance. 20 minutes prior to the end of the procedure, the Mullimix infusion rate was reduced to 0.1 ml/kg/h, and after an initial 10 ml dose of ropivacaine0.3% epidurally, a continuous epidural infusion of 0.2%ropivacaine was initiated. In addition, paracetamol 1 g, parecoxib 40 mg and 40 mg/kg MgSO4 over 20 minutes were administered.
Results Mullimix was infused for 155 minutes, with a total administered volume of 42 ml (21μg dexmedetomidine,210 mg lidocaine and 21 mg ketamine).The patient remained hemodynamically stable, a 3–4/10 VAS score was achieved and no nausea, vomiting, disturbing dreams or delirium were noted.
Conclusions The Mullimix solution, in combination with regional anaesthesia, appears to be a good choice for the management of patients with opioid allergies, providing a high level of perioperative analgesia.
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