Perioperative Management of Opioid Tolerant Patients

The increase in worldwide prescription opioidOpioids use has resulted in a parallel increase in the need to consider the analgesicAnalgesics management of patients who are opioidOpioids-tolerant. OpioidsOpioids provide effective analgesiaAnalgesia; however, effective utilization can be limited by opioidOpioids-related adverse events and abuse potential. The use of multimodal analgesicAnalgesics therapy has been recommended by numerous societies and entails the concurrent perioperativePerioperative utilization of multiple pharmacologic and/or non-pharmacologic agents with different mechanisms of action. The perioperative periodPerioperative period represents a vulnerable time for opioidOpioids tolerant patients due to the riskRisks of undertreatment of pain, riskRisks of opioidOpioids withdrawal and relapse, not to mention the fear of possible adverse judgment by providers. This chapter presents current recommendations in the perioperative managementPerioperative management of opioidOpioids tolerant patients. While the management of these patients may be challenging, leveraging, multimodal therapies and multi-disciplinary planning and strategies remain essential components of optimized perioperative analgesiaPerioperative analgesia.