Managing Opioid-Tolerant Patients in the Perioperative Surgical Home

Anesthesiol Clin. 2016 Jun;34(2):287-301. doi: 10.1016/j.anclin.2016.01.005.


Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge.

Keywords: Buprenorphine; Multimodal analgesia; Opioid tolerance; Perioperative surgical home.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Drug Tolerance
  • Humans
  • Intraoperative Care
  • Ketamine / therapeutic use
  • Pain, Postoperative / drug therapy*
  • Postoperative Care
  • Preoperative Care


  • Analgesics, Opioid
  • Ketamine