Post Operative Recovery of Opioid Tolerant Patients

  • Ms Jayne McCarthur, Postanaesthesia Recovery, Royal Adelaide Hospital, Australia, Australia
  • Ms Tara Kennedy, Postanaesthesia Recovery, Royal Adelaide Hospital, Australia, Australia
  • Dr Tim Semple, Chronic Pain Unit, Royal Adelaide Hospital, Australia, Australia
  • Mr Lyell Brougham, Postanaesthesia Recovery, Royal Adelaide Hospital, Australia, Australia
  • Associate Professor Peggy Compton, School of Nursing, University of California, Los Angeles, USA, United States
  • Professor Charlotte de Crespigny, Discipline of Nursing/ Drug and Alcohol Services of South Australia, University of Adelaide, Australia, Australia
  • Mr Peter Athanasos, Discipline of Nursing, University of Adelaide, Australia, Australia

    • Aims: Patients on moderate to high daily doses of opioids for the treatment of chronic pain or substance use are perceived to have higher perioperative analgesic requirements and more complicated recovery. Due to a lack of identification of these clients prior to surgery, perioperative pain management can be compromised. We examined analgesic requirements, pain experience, and period of time following surgery for two groups of opioid tolerant patients (chronic pain and substance use)(n=77) and compared them to a non opioid tolerant control group (controls)(n=41). We also examined effect of introducing identification at preoperative medical assessment of suspected opioid tolerance in patients maintained on opioids prior to surgery to ensure optimal pain management. Methods: We examined following markers prior to and subsequent to introduction of formal identification of suspected opioid tolerance and compared them to controls: quantity of analgesia perioperatively (morphine equivalents), time of opioid administration protocol, total time spent in recovery and most severe to least severe pain (Visual Analogue Scale)(VAS). Preliminary Results: Opioid tolerant patients required significantly more (30±3 SEM mg vs 13±2) (p=0.0007) morphine equivalent analgesia and significantly longer opioid administration protocol (82±12 minutes vs 40±9)(p=0.02) than controls. Interestingly, there was no difference in total time spent in recovery between opioid tolerant and controls (opioid tolerant 177±13 minutes vs 177±18) (p=0.99) or changes in pain experience (opioid tolerant 4.5±0.3 VAS vs controls 4.4±0.3) (p=0.88). Additionally, quantity of analgesia was compared before and after formal identification of opioid tolerant group and compared to controls.
    Conclusion: Opioid tolerant patients require more analgesia and longer opioid administration protocols than non-opioid tolerant controls but length of time in recovery and changes in reported pain experience were similar. Further findings will provide evidence concerning efficacy of identification of opioid tolerance prior to surgery and subsequent pain management in the perioperative period.