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Suspected opioid-induced hyperalgesia in an infant following surgery: A case report
Proshad N Efune1,2, Sarah E Rebstock1
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Insights
Opioid-induced hyperalgesia (OIH) in infants is challenging to diagnose. This case study suggests ketamine may effectively treat OIH in infants experiencing worsening pain post-surgery despite increased opioid doses.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Opioids are frequently used for infant surgical pain management.
- Opioid-induced hyperalgesia (OIH) is a recognized adverse effect in adults, but identification in infants is complex.
- Postoperative pain management in infants requires careful consideration of opioid side effects.
What Is Known And Objective:
Opioids are commonly administered to infants having surgery. Opioid induced hyperalgesia (OIH) is a known adverse effect of opioids in adults but can be difficult to identify in infants.
Case Summary:
A 3-month-old received high-dose fentanyl during anorectoplasty for imperforate anus. He had signs and symptoms of OIH immediately after surgery. His pain and agitation were difficult to manage but improved after he received ketamine.
What Is New And Conclusion:
OIH should be considered in infants postoperatively when pain worsens despite administration of escalating doses of opioids. Ketamine can be an effective therapeutic for OIH.
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