Opioids are one of the longest known and used drug groups. Due to their specific pharmacodynamic and pharmacokinetic actions, their use is often subject to uncertainty or hesitation on the part of both patients and physicians. In this algorithm, we will look at their use in practice in the role of the pain specialist and anaesthesiologist, in particular the setting of chronic medication - escalation and de-escalation of therapy, management of common side effects and adaptation of analgesia in the perioperative period.
The algorithm presents a clinical case concerning titration of effective opiod treatment in a pre-op patient with chronic pain in the face of insufficient effect of maximal tramadol dose with acetaminophen. It guides the user through the management of adverse effects of transdermal buprenorphine, management of opioid induced constipation. Acute control of pain in the peri-operative period is covered, as is gradual withdrawal of opioids after surgical correction of the underlying condition.
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