Background

• CCF
• Angina- DSE no inducible ischaemia
  • cardiologist cleared for TKR
• NIDDM
• Frailty
• Chronic pain – hip and back
• High dose opioid use -100mg/day morphine equivalent
  • Pain specialist letter recommends perioperative weaning as pain not opioid responsive.
  • Interventional pain procedure as alternate treatment organised previously – short-term relief only
  • Further interventional pain options possible, but pain specialist suggesting need for surgery to facilitate analgesia

Issues

• Should we postpone for opioid weaning preoperatively – will the delay provide perioperative risk-reduction?

Discussion

• Difficult situation – traditional push for opioid-weaning perioperatively to facilitate better postoperative analgesia
• FPM seminar at ANZCA perioperative SIG (Dr Noam Winter):
  • Increased push for opioid weaning perioperatively can be problematic
  • Risk with sudden weaning or stopping opioids – withdrawal, depression, mental health decline
• Consensus in the group that perioperative encouragement and liaison with pain specialist GP for Opioid rotation/ weaning appropriate
  • Must be under specialist supervision

Plan

• Don’t delay surgery for weaning – Liaise with GP to commence opioid reduction plan preop to continue post operatively