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 cannot 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 any more in my place. What can be done for me? Also, I am currently on 50 mg Oxycodone per day and Zohydro 80 mg for pain so my tolerance for opiates has gone way up.
Hi. From your brief history, I can sense that you have already become tolerant to opioids. Once tolerance develops to one group of opioids, simultaneously other opioids also develop the same way. I would suggest the addition of Clonidine, Dexmedetomidine through your spinal catheter since opioid-tolerant patients do have good postoperative 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.