Epidural dexmedetomidine infusion in a patient with chronic opioid use and intractable pain following abdominoperineal resection

Mathew P Silvaggio; Melanie K Toman; Braden Peters

doi:10.1093/omcr/omaa021

Epidural dexmedetomidine infusion in a patient with chronic opioid use and intractable pain following abdominoperineal resection

Oxf Med Case Reports. 2020 May 23;2020(4):omaa021. doi: 10.1093/omcr/omaa021. eCollection 2020 Apr.

Authors

Mathew P Silvaggio¹, Melanie K Toman², Braden Peters³

Affiliations

¹ Department of Anesthesia, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
² Department of Anesthesia, Lakeridge Health, Oshawa, ON, Canada.
³ Faculty of Medicine, Northern Ontario Medical School, Lakehead University, Thunder Bay, ON, Canada.

Abstract

Dexmedetomidine is a selective alpha 2 adrenergic agonist with known analgesic properties. Its perioperative use is associated with reduced pain scores and an opioid sparing effect. Management of postoperative pain in patients with a history of chronic opioid use can be challenging. Multimodal analgesia is recommended although the perioperative use of dexmedetomidine has not been extensively studied in this patient population. We present a case of intractable abdominal pain following open abdominoperineal resection in a patient with rectal cancer and a history of chronic opioid use. Following the introduction of dexmedetomidine into the patient's postoperative epidural solution, a noticeable decline in reported pain scores and use of breakthrough analgesia was appreciated. The analgesic efficacy of epidural dexmedetomidine in patients with a history of chronic opioid use warrants further study.

Keywords: analgesia; dexmedetomidine; epidural; postoperative pain.