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#36300 ‘Fetty tranq’ – a multidisciplinary approach to surgical and acute pain management
  1. Dennis Warfield1,
  2. Mikayla Borusiewicz2,
  3. Isha Joshi3,
  4. Donald Dissinger4,
  5. Lori Amertil1,
  6. Michelle Gniady2 and
  7. Taffy Anderson4
  1. 1Division of Regional Anesthesiology and Acute Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
  2. 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
  3. 3Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
  4. 4Interdisciplinary Addiction Medicine, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Hershey, USA


Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims There has been dramatic rise in polysubstance abuse including utilization of synthetic compounds. A new combined agent known colloquially as ‘Fetty Tranq’ is an emerging threat. Xylazine, a non-opioid veterinary tranquilizer with direct alpha-2 adrenergic receptor agonism, is being combined with street fentanyl to extend effects and enhance euphoria. Through alpha-adrenergic effects, xylazine produces local vasoconstriction leading to characteristic and progressive wound presentation. Epidemiologic studies demonstrate geographical predominance of this toxic combination in the Northeastern United States, particularly in the city of Philadelphia. The latest health update released by the Philadelphia Department of Public Health in December of 2022 reported detection of xylazine in 90% of street opioid samples.

Methods 41-year-old male with several year history of intravenous drug use presented with several islands of necrotic wounds on bilateral lower extremities. Addiction medicine consulted for withdrawal and pain management in setting of active substance use. Patient taken to OR by plastic surgery for excisional debridement of wounds. Right popliteal-sciatic and left adductor canal catheters placed for postoperative pain management by RAAPM service.

Results Important to recognize, identify and transfer to appropriate level and range of care. This is not a ‘Narcan-resistant opioid’, but rather a combination of two chemicals with physical and psychological consequences.

Abstract #36300 Figure 1

Initial presentation and characteristic appearance for (different) patient presenting with upper extremity wound after intravenous use of xylazine mixed with fentanyl

Abstract #36300 Figure 2

Postoperative day 11: Inpatient status-post skin grafting (right lower extremity)

Abstract #36300 Figure 3

Postoperative day 21: Outpatient follow-up with interval wound healing (right lower extremity)

Conclusions After one-month follow-up post grafting to bilateral lower extremities, patient continues local wound care with non-adherent dressings and minimal pain. Purpose of this case report is to exemplify team-based approach and global view of treatment for patient in need of withdrawal treatment, surgical wound care and multimodal analgesia.

  • opioid epidemic
  • xylazine
  • fentanyl
  • acute pain management
  • withdrawal
  • skin necrosis
  • ‘Fetty Tranq’
  • ‘Zombie drug’

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