Perioperative pain management in patients with chronic opioid use

Abstract

Patients with chronic opioid use present a clinical challenge in perioperative management due to tolerance and the risk of opioid-induced hyperalgesia. This article discusses evidence-based strategies for effective pain management in these patients, highlighting multimodal analgesia, preoperative planning, and rigorous postoperative monitoring. It also explores the role of multidisciplinary teams, pharmacological and non-pharmacological approaches, as well as postoperative rehabilitation protocols. Opioid-induced hyperalgesia, caused by central nervous system adaptations, requires specialized techniques to mitigate its effects. In preoperative planning, the need for a detailed evaluation of the patient’s opioid use history, identification of comorbidities, and discussion about pain control expectations is emphasized. During the perioperative period, multimodal analgesia has proven essential, combining agents such as NSAIDs, local anesthetics, and adjuvant medications like gabapentin and ketamine. Postoperative monitoring must be rigorous, focusing on identifying complications and optimizing early rehabilitation. This study reinforces the need for integrated and individualized management that ensures patient safety and improves clinical outcomes. Reviewing evidence-based strategies advances knowledge in the field of perioperative pain management, proposing solutions to an increasingly prevalent issue in clinical practice.