CLINICAL REPORT Opioid-Free Perioperative Analgesia for Hemicolectomy in a Patient With Opioid-Induced Delirium: A Case Report and Review of the Analgesic Efficacy of the Alpha-2 Agonist Agents Sheetal K. Patil, MD; Magdalena Anitescu, MD, PhD Anesthesia and Critical Care Medicine, University of Chicago Medical Center, Chicago, Illinois, U.S.A. n Abstract: Surgical pain in patients with documented opioid-induced delirium can be difficult to treat. We pres- ent a case of a patient undergoing laparoscopic hemicolec- tomy 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 lapa- roscopic hemicolectomy for redundant right colon. Her medical history included a recently diagnosed postopera- tive 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 com- fortable with pain scores of 1 to 2/10 on Numerical Rating Scale (NRS). On postoperative day 1, the infusion was dis- continued and the clonidine, 12 lg/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 abdom- inal distention because of abscess formation rendered a new surgical intervention. The analgesia for the explor- atory laparoscopy was maintained using epidural clonidine and bupivacaine infusion as well as intravenous dexmede- tomidine, which were maintained another 2 days. Pain scores remained minimal until discharged home 3 day later. Discussion: Nonopioid analgesic regimens are benefi- cial in patients at risk of postoperative cognitive dysfunc- tion attributable to opioids. Successful postoperative analgesia was achieved in our patient by alternating various routes of administration of alpha-2 adrenoreceptor agonists. n Key Words: dexmedetomidine, epidural, delirium, cloni- dine, bupivacaine, alpha-2 agonists Address correspondence and reprint requests to: Magdalena Anite- scu, MD, PhD, Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Ave, MC 4028, Chicago, IL 60637, U.S.A. E-mail: manitescu@dacc.uchicago.edu. Submission: June 14, 2011; Revision accepted: January 14, 2012 DOI. 10.1111/j.1533-2500.2012.00543.x Ó 2012 The Authors Pain Practice Ó 2012 World Institute of Pain, 1530-7085/12/$15.00 Pain Practice, Volume ••, Issue •, 2012 ••–••