How can morphine-sensitive people control pain after surgery?

Question

Hello doctor,

I am undergoing major spinal deformity surgery next month, anterior and posterior. I am 50 years old, and this is my fourth scoliosis surgery.

In recent years, I have developed a sensitivity to Morphine, and I can not take Dilaudid (Hydromorphone) because it gives me terrible headaches. What other options are available to put into my spinal catheter for post-operative pain control in the hospital? I know that Fentanyl is short-acting and they do not use Demerol anymore in my place. What can be done for me? Also, I am currently on 50 mg of Oxycodone per day and Zohydro 80 mg for pain, so my tolerance for opiates has gone way up. Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

From your brief history, I can sense that you have already become tolerant of opioids. Once tolerance develops to one group of opioids, simultaneously other opioids also develop the same way. I would suggest the addition of Clonidine and Dexmedetomidine through your spinal catheter since opioid-tolerant patients do have good post-operative pain relief with this drug.

Multimodal analgesia with intravenous Ketorolac, Buprenorphine through the spinal route can be another option. But I do not know whether your anesthesiologist is comfortable with these drugs. Kindly have a discussion with your physician.

I hope that you get your answer.

Please let me know if you need any help.

Thank you.