ABSTRACT
Pain relief is principally a problem in opioid addicts. The advice given by Wood and Soni is as follows (see Further reading).
Opioid addicts may present with a background of illicit street use, or more rarely they may be under supervision on a methadone-maintenance programme. The following principles are important in perioperative management:
• The addict’s usual total daily dose should be discovered. This must then be considered a ‘physiological requirement’ and it (or an equipotent dose of another narcotic) becomes the minimal daily requirement irrespective of additional considerations of acute pain relief, background analgesic, or sedation. Analgesic requirements will be excessive and withdrawal precipitated if the principle is not observed. This principle must not be neglected if regional techniques are employed.
