Peri-Operative Management of Patients on Strong Opioids

Abstract

Start background opioid infusion via PCA early if required
Regularly re-assess pain post-operatively and check for signs of withdrawal e.g. unexplained tachycardia, restlessness, confusion
Switch parenteral opioids to oral or transdermal medication as early as possible using the last 24 hours opioid consumption as a guide: give 50–75% of total dose as slow-release opioid orally or via transdermal route with the remainder given as required
Consider a trial of an opioid rotation if pain control inadequate
Consider the use of adjunctive medication including ketamine, clonidine and     gabapentin for opioid sparing effects.
Do not try to solve a chronic pain problem in the post operative period