The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report
Background As Canada continues to address challenges related to the opioid crisis, individuals suffering from opioid use disorder (OUD) can be especially vulnerable to physical and psychological destabilization after surgery. Adopting a harm reduction approach postoperatively can be a success factor...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2021-01-01
|
| Series: | Canadian Journal of Pain |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/24740527.2021.1952066 |
| _version_ | 1819096376750899200 |
|---|---|
| author | Salima S. J. Ladak Gonzalo Sapisochin P. Maxwell Slepian Hance Clarke |
| author_facet | Salima S. J. Ladak Gonzalo Sapisochin P. Maxwell Slepian Hance Clarke |
| author_sort | Salima S. J. Ladak |
| collection | DOAJ |
| description | Background As Canada continues to address challenges related to the opioid crisis, individuals suffering from opioid use disorder (OUD) can be especially vulnerable to physical and psychological destabilization after surgery. Adopting a harm reduction approach postoperatively can be a success factor for safe recovery and satisfactory analgesia. Purpose We present the case of a 40-year-old patient (referred to as DC) with OUD using illicit fentanyl, heroin, and oxycodone preoperatively and admitted for an elective liver resection for steroid-induced hepatoma. Despite a preoperative anesthesia assessment and the initiation of a standard balanced multimodal analgesic regimen, suboptimal analgesia was evident in the first 24 h postoperatively. This lack of analgesic efficacy precipitated DC’s use of illicit self-injected intravenous (IV) opioid and significant emotional distress. To address this, a nurse practitioner and anesthesiologist within the Toronto General Hospital acute and transitional pain program and the surgical team quickly met and adopted a harm reduction approach to manage DC’s postoperative pain and emotional distress. The ultimate goal was to eliminate self-administration of illicit IV opioids and prevent DC from attempting to leave hospital against medical advice. Following an interprofessional team discussion that included DC, IV fentanyl was offered via a patient-controlled analgesia pump to DC’s satisfaction (exceeding standard settings), providing acceptable pain relief. To our knowledge, DC did not self-administer additional illicit drugs during the remainder of hospitalization. Outcome This harm reduction approach resulted in DC’s safe recovery, achievement of postoperative functional milestones, and continued engagement with outpatient pain treatment. |
| first_indexed | 2024-12-21T23:58:13Z |
| format | Article |
| id | doaj.art-8c2d82a4088e4a6b95234c025c85eb33 |
| institution | Directory Open Access Journal |
| issn | 2474-0527 |
| language | English |
| last_indexed | 2024-12-21T23:58:13Z |
| publishDate | 2021-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Canadian Journal of Pain |
| spelling | doaj.art-8c2d82a4088e4a6b95234c025c85eb332022-12-21T18:45:46ZengTaylor & Francis GroupCanadian Journal of Pain2474-05272021-01-015116617110.1080/24740527.2021.19520661952066The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case reportSalima S. J. Ladak0Gonzalo Sapisochin1P. Maxwell Slepian2Hance Clarke3University Health NetworkUniversity of TorontoUniversity Health NetworkUniversity Health NetworkBackground As Canada continues to address challenges related to the opioid crisis, individuals suffering from opioid use disorder (OUD) can be especially vulnerable to physical and psychological destabilization after surgery. Adopting a harm reduction approach postoperatively can be a success factor for safe recovery and satisfactory analgesia. Purpose We present the case of a 40-year-old patient (referred to as DC) with OUD using illicit fentanyl, heroin, and oxycodone preoperatively and admitted for an elective liver resection for steroid-induced hepatoma. Despite a preoperative anesthesia assessment and the initiation of a standard balanced multimodal analgesic regimen, suboptimal analgesia was evident in the first 24 h postoperatively. This lack of analgesic efficacy precipitated DC’s use of illicit self-injected intravenous (IV) opioid and significant emotional distress. To address this, a nurse practitioner and anesthesiologist within the Toronto General Hospital acute and transitional pain program and the surgical team quickly met and adopted a harm reduction approach to manage DC’s postoperative pain and emotional distress. The ultimate goal was to eliminate self-administration of illicit IV opioids and prevent DC from attempting to leave hospital against medical advice. Following an interprofessional team discussion that included DC, IV fentanyl was offered via a patient-controlled analgesia pump to DC’s satisfaction (exceeding standard settings), providing acceptable pain relief. To our knowledge, DC did not self-administer additional illicit drugs during the remainder of hospitalization. Outcome This harm reduction approach resulted in DC’s safe recovery, achievement of postoperative functional milestones, and continued engagement with outpatient pain treatment.http://dx.doi.org/10.1080/24740527.2021.1952066opioidoverdoseharm reductionpostoperative painsafety |
| spellingShingle | Salima S. J. Ladak Gonzalo Sapisochin P. Maxwell Slepian Hance Clarke The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report Canadian Journal of Pain opioid overdose harm reduction postoperative pain safety |
| title | The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report |
| title_full | The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report |
| title_fullStr | The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report |
| title_full_unstemmed | The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report |
| title_short | The intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery: A case report |
| title_sort | intersection of harm reduction and postoperative care for an illicit fentanyl consumer after major surgery a case report |
| topic | opioid overdose harm reduction postoperative pain safety |
| url | http://dx.doi.org/10.1080/24740527.2021.1952066 |
| work_keys_str_mv | AT salimasjladak theintersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT gonzalosapisochin theintersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT pmaxwellslepian theintersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT hanceclarke theintersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT salimasjladak intersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT gonzalosapisochin intersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT pmaxwellslepian intersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport AT hanceclarke intersectionofharmreductionandpostoperativecareforanillicitfentanylconsumeraftermajorsurgeryacasereport |