Post-operative analgesic regime in a patient with congenital indifference to pain

A man in his thirties with congenital indifference to pain with anosmia (CIP) presented to a tertiary centre for an elective biopsy and video-assisted thoracoscopic surgery. Intra-operatively, he demonstrated no autonomic reflex in response to intubation or surgical stimulus, out of keeping with similar case reports in the medical literature. Post-operatively, he developed intermittent tachycardia, hypertension and pyrexia, which was controlled with opioid and non-opioid-based analgesics. Post-operative pyrexia and tachycardia alerted the patient to a developing chest infection, resulting in re-admission. Learning points include the importance of regular and accurate national early warning score documentation in patients with CIP, and the utility of conventional analgesia in tempering the autonomic response to stress in this patient group.