Assessment and Management of the Opioid Tolerant Patient During the Perioperative Period

Currently, management of chronic pain patients in a perioperative setting continues to be a challenge for every anesthesia provider. The challenges faced include opioid-induced hyperalgesia, patient satisfaction with their pain control, prevention of long-term disability, and issues of delayed mobilization due to uncontrolled pain. These challenges may occur due to under medication or lack of balanced analgesia techniques. Conversely, overmedication can lead to postoperative respiratory insufficiency with prolonged ventilator dependence and associated complications increasing length of hospital stay. These challenges are complicated for experienced providers; therefore, student registered nurse anesthetists (SRNAs) beginning their clinical rotations will find managing these patients an even greater challenge. The goal of this project was to provide tools for use in the care of patients with chronic pain. Tools that were provided included introducing the new SRNA to an in-depth preoperative pain assessment, a thorough understanding of the pathophysiology of acute and chronic pain development, dosing and regimens of analgesic adjuncts to be utilized concomitantly with opioids, and the use of equi-analgesic opioid dosing to plan appropriate interventions to improve the future health of their patients. Case scenarios were discussed to emphasize multimodal analgesia techniques to reduce the negative side effects of a pure opioid analgesia technique.