Are Opioid-tolerant Patients Resistant to Local Anesthetic Nerve Blockade?: We Need More Information

Erector spinae plane block for management of acute opioid withdrawal in the emergency department: A case report

BACKGROUND

Gastrointestinal symptoms of acute opioid withdrawal are distressing for patients and are often difficult to manage with conventional therapies. Insufficiently managed opioid withdrawal symptoms may lead patients to leave against medical advice, which can increase their risk of relapse and result in poor outcomes from untreated conditions. We assessed the impact of an erector spinae plane block on the acute gastrointestinal symptoms of opioid withdrawal.

CASE REPORT

A 44-year-old woman with opioid use disorder presented to the ED with severe gastrointestinal symptoms of opioid withdrawal, refractory to parenteral opioid agonists and symptomatic treatment. She underwent an ultrasound-guided erector spinae plane block with 30 mL of 0.25 % bupivacaine which completely resolved her gastrointestinal symptoms.

CONCLUSION

Through blockade of the sympathetic chain, the erector spinae plane block could provide targeted symptomatic relief for patients presenting with severe gastrointestinal symptoms of opioid withdrawal. Future research should seek to evaluate the efficacy observed in this case in larger patient populations.

Predictors of pain during phacoemulsification under local sedation: A multicentric study

PURPOSE

To assess the risk factors for pain during cataract surgery under local anesthesia.

METHODS

This multicentric observational study assessed risk factors for pain during cataract surgery from June to November 2020 in a private clinic and two university hospitals (France). Adults who underwent cataract surgery under local anesthesia with conscious sedation were consecutively included. Exclusion criteria were locoregional anesthesia and an inability to communicate. Once the surgical drape was removed, patients rated the pain on a numerical rating scale (NRS) from 0 to 10, after the surgical drape was removed. Clinical and biometric parameter data were retrieved from medical records. Multivariate logistic regression was used to determine factors associated with pain during cataract surgery.

RESULTS

Among the 387 eyes (330 patients), 53 (13.7%) were classified by patients as painful (numerical rating scale [NRS] score≥4). An intraoperative painful eye (NRS score≥4) was associated with intraocular lens (IOL) power<19 D (OR=2.78, P=0.005), chronic analgesic use (OR=4.34, P=0.011), and brown or white type of cataract (OR=5.68, P=0.008).

CONCLUSION

In conclusion, anesthesia should be adapted for myopic eyes with IOL power<19 D, chronic analgesic use, and brown or white cataract. A larger study may help develop a predictive score for pain that could, for example, be integrated into a biometer.

Perioperative Pain Management for Median Sternotomy in a Patient on Chronic Buprenorphine/Naloxone Maintenance Therapy: Avoiding Opioids in Patients at Risk for Relapse

The opioid crisis in the United States has been pandemic. As such, anesthesia providers are frequently faced with patients who have a history of opioid abuse or are currently receiving chronic therapy for such disorders. The chronic administration of medications such as buprenorphine-naloxone can impact the choice of perioperative anesthesia and pain control. Furthermore, the postoperative administration of opioids may lead to relapse in patients with a history of opioid abuse. We present a 26-year-old male with a history of opioid abuse on maintenance therapy with buprenorphine-naloxone, who presented for median sternotomy, cardiopulmonary bypass, and pulmonary valve replacement. The perioperative implications of buprenorphine-naloxone and implementation of multimodal analgesia are discussed, along with options to decrease or eliminate the perioperative use of opioids.