Acute Pain Control Challenges with Buprenorphine/Naloxone Therapy in a Patient with Compartment Syndrome Secondary to McArdle's Disease: A Case Report and Review
| Autor: | Samuel K. Chu, Zachary L McCormick, Petra Joseph, George C Chang-Chien |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Narcotic Antagonists medicine.medical_treatment Compartment Syndromes Injections Intramuscular Rhabdomyolysis Naloxone medicine Humans Hydromorphone Creatine Kinase Acetaminophen Pain Measurement Patient-controlled analgesia business.industry Chronic pain Analgesia Patient-Controlled General Medicine Analgesics Non-Narcotic Middle Aged Opioid-Related Disorders medicine.disease Acute Pain Buprenorphine Surgery Analgesics Opioid Drug Combinations Anesthesiology and Pain Medicine Opioid Hydrocodone Anesthesia Glycogen Storage Disease Type V Neurology (clinical) business Oxycodone medicine.drug |
| Zdroj: | Pain Medicine. 14:1187-1191 |
| ISSN: | 1526-4637 1526-2375 |
| Popis: | Objective We report the first case of non-iatrogentic exertional rhabdomyolysis leading to acute compartment syndrome in a patient with McArdle's disease. We describe considerations of concurrent buprenorphine/naloxone therapy during episodes of severe acute pain. Design Case report. Case Presentation A 50-year-old male with a history of McArdle's disease, taking buprenorphine/naloxone for chronic pain and opioid dependence, presented to the Emergency Department with severe bilateral anterior thigh pain. Over the following 8 hours, he was given a total of 12 mg of intravenous hydromorphone with minimal pain relief. The decision was made to initiate patient-controlled analgesia (PCA) with hydromorphone started at 0.5 mg as needed with a 15-minute lockout. Subsequently, the patient's anterior thighs were found to be extremely tense. His creatine kinase level rose to 198,688 units/L and compartment pressures were greater than 90 mm Hg bilaterally. The patient was taken for emergent bilateral fasciotomies. The hydromorphone PCA was increased to 0.8 mg as needed with a 15-minute lockout and a basal rate of 0.5 mg/h. The patient's reported pain plateaued at 3/10 intensity 2 days after surgery, and he was transitioned to oxycodone and hydrocodone/acetaminophen. He followed up with his pain management physician 2 months later who restarted suboxone and a buphrenorphine transdermal patch. Discussion Buprenorphine/naloxone is being prescribed off-label with increasing frequency for pain management in patients with or without a history of opioid abuse. Severe acute pain is more difficult to control with opioid analgesics in patients taking buprenorphine/naloxone, requiring higher than usual doses. If buprenorphine/naloxone is discontinued to better treat acute pain with other opioids, monitoring for overdose must take place for at least 72 hours. |
| Databáze: | OpenAIRE |
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