167 ISSN 1758-1869 Pain Manag. (2015) 5(3), 00–00 part of Pain Management 10.2217/PMT.15.13 © 2015 Future Medicine Ltd e K 3 SPECIAL REPORT 2015/04/28 Management of acute pain in patients on treatment with opioids d, z te t - Jose De Andres* ,1,2 , Gustavo Fabregat-Cid 1 , Juan Marcos Asensio-Samper 1 , Nerea Sanchis-Lopez 1 & Susana Moliner-Velazquez 1 1 Multidisciplinary Pain Management Department. Department of Anesthesiology Critical Care & Pain Management, General University Hospital, Valencia, Spain 2 Department of Surgical Specialties, School of Medicine, Valencia, Spain *Author for correspondence: Tel.: +34 961 972 138; Fax: +34 961 972 182; deandres_jos@gva.es E SUMMARY The use of opioids for both benign and cancer-related chronic pain has increased exponentially over the last few years. For this reason, increasing numbers of such patients are presenting for surgery. It is known that continuous use of opioids is associated with an increase in postoperative analgesic requirements. This is believed to be mediated by the development of tolerance and opioid-induced hyperalgesia. Patients treated with opioids have special needs in the perioperative setting and it is the anesthesiologist’s responsibility to manage these needs optimally. The aim of the present paper is to briely orient the reader in the management of postoperative pain in patients chronically treated with licit opioids. KEYWORDS: • acute pain • chronic opioids • opioids • opioid- induced hyperalgesia • opioid tolerance • pain • postoperative pain Practice points ● The number of patients on long-term treatment with opioids for chronic pain presenting for surgery has signiicantly increased in the last years. ● Patients treated with opioids have an increase in analgesic requirements (it is believed to be mediated by the development of tolerance and opioid-induced hyperalgesia). ● A multidisciplinary and multimodal approach is necessary to ensure the success in the management of this subset of patients. ● Preoperatively: maintain or initiate appropriate preoperative medications (prior dose of opioids, COX inhibitors or nonsteroidal anti-inlammatory drugs). ● Intraoperatively: regional techniques are preferred, preferably continuous techniques, although no anesthetic technique has shown better. ● Manage opioids to meet the following requirements: • Chronic preoperative needs. • Intraoperative needs due to surgery (which can be higher than in patients opioids naive). ● Postoperatively: the use of PCA for pain control is a useful alternative. ● Conclusion • Patients treated with opioids have special needs in the perioperative setting and it is the anesthesiologist’s responsibility to manage these needs optimally. Author Proof