Opioid-Free Anesthesia in Patients with the Opioid Dependence Syndrome during Cardiac Surgery

Introduction: Special features of anesthetic management of drug users can be attributed to addiction, abstinence, adverse effects of anesthetic agents and other medications used during the general anesthesia as well as the co-morbidities developed due to frequent drug injections.

Case Report: A man, age 48, weight 73 kg, was admitted to hospital for surgery with inactive infective endocarditis of atrioventricular valves and a history of opioid dependence. 5 years in remission. Combined mitral and tricuspid valve repair was performed.

During anesthesia we used Acetaminophen, Gabapentin, Dexmedetomidine, Ketamine, Lidocaine, Magnesium sulfate, Bupivacaine. After surgery the patient was transferred to the ICU. Extubated 45 minutes post-surgery.

During surgery, there were no hemodynamic changes associated with pain. Postoperatively, spontaneous breathing, reflexes, and motor activity were restored without severe pain, there was no need for opioid analgesia. After discharge, the patient did not show symptoms of opioid dependence.

Discussion: The use of opiates in high doses for drug users can lead to adverse effects: less effective mobilization, dose-dependent side effects negatively affecting the patient’s comfort and slowing down post-operative rehabilitation, dose-dependent hyperalgesia as a source of acute and chronic pain. Post-surgery, several analgesics of different classes are used to optimize analgesia and limit the side effects associated with using analgesics of various classes.

Conclusion: Multimodal approach to opioid-free anesthesia and postoperative analgesia in patients with opioid dependence in remission allows to achieve good analgesia and prevents exacerbation of opioid dependence after surgery.