Surgical
pain in patients with documented
opioid-induced
delirium can be difficult to treat. We present a case of a patient undergoing laparoscopic
hemicolectomy effectively treated with an
opioid-free, alpha-2 adrenoreceptor agonist
analgesic regimen.
CASE REPORT: A 21-year-old woman with persistent
abdominal pain presented to the operating room for laparoscopic
hemicolectomy for redundant right colon. Her medical history included a recently diagnosed postoperative
opioid-induced
delirium. Epidural infusion with
local anesthetic offered partial
pain relief with sensory levels of T9-L2. With the addition of
dexmedetomidine infusion in the immediate postoperative period, the patient was comfortable with
pain scores of 1 to 2/10 on Numerical Rating Scale (NRS). On postoperative day 1, the infusion was discontinued and the
clonidine, 12 μg/hours was added to the epidural
bupivacaine. With increased sedation 48 hours later, neuraxial
clonidine was discontinued in favor to transdermal
clonidine 0.1 mg/week, which was maintained until hospital discharge.
Pain scores were maintained at 2 to 3/10 on NRS for the next 3 days when increased abdominal distention because of
abscess formation rendered a new surgical intervention. The
analgesia for the exploratory laparoscopy was maintained using epidural
clonidine and
bupivacaine infusion as well as intravenous
dexmedetomidine, which were maintained another 2 days.
Pain scores remained minimal until discharged home 3 day later.
DISCUSSION: