Pain management in the opioid-tolerant patient undergoing day surgery

The rate of ambulatory surgery is increasing worldwide and the rate of patients receiving opioids for chronic non-cancer pain and cancer pain is rising. There is also a percentage of the population who are receiving opioids as part of an opioid substitution programme and individuals who may be abusing prescribed and non-prescribed opioids, which means that personnel working in these areas are more likely to encounter a patient who is opioid-tolerant. Evidence has shown that these patients benefit most from a multi-modal approach to postoperative analgesia in the day surgery setting, with a clear pain management plan that involves the multidisciplinary team. This includes the utilisation of opioid and non-opioid analgesia and regional techniques which will enhance their recovery and reduce side effects such as nausea, vomiting and sedation, which may delay discharge home and subsequent recovery. Adequate discharge planning is essential with education of the patient and communication with the GP, pain specialist, drug/alcohol team or addiction specialist to ensure a return to baseline opioid use as soon as possible. Keywords: Opioid tolerance, day surgery, multimodal analgesia, non-opioid analgesia, opioid analgesia.