Abstract

Perioperative Pain Management Performed by Interdisciplinary Health Team for a Patient with Opioid Addiction History: A Case Report

Objective: Pain is the most significant problem for postoperative patients in clinical practice, and it greatly affects the physical and mental health of patients and the process of postoperative rehabilitation. Patients with opioid addiction history are not only more sensitive to pain but also may be more likely to become re-addicted, making postoperative acute pain management more challenging. Methods: This article introduces the perioperative multidisciplinary pain management of an American patient with opioid addiction history. Before the surgery, the pharmacist, anesthesiologist, surgeon, nurse, and physical therapist together established a perioperative pain management plan for this patient. This plan is based on multimodal analgesia, the WHO analgesic ladder, treatment with low-dose strong opioids, on-time administration, and non-pharmacological interventions. Result: The pain score (visual analog scale) during activity was 1-3 out of 10 points, and the resting pain was 0-2 out of 10 points. No signs of addiction were found. The patient could complete 100% of the planned exercises and achieved an active knee flexion angle of 90° at discharge. Conclusion: This is the first patient we ever met who had opioid addiction history, which required both high skills of pain management and culture competence from us. The main contribution of this paper is to combine our case with a literature review, thus providing a multidisciplinary acute and breakthrough pain control protocol for patients with opioid addiction history. Finally, based on the clinical experience and literature review, this study revealed the stereotypes and underuse of opioids among Chinese doctors and patients and clarified the importance of nursing cultural competence in light of economic and medical globalization.

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