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3981
Dexmedetomidine as an Adjuvant Analgesic in Intractable Graft versus Host Disease Pain in a Patient taking Buprenorphine
Session: MP-05a
Fri, Nov. 17, 8:00-10:00 am
Hampton Room

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A Case Report: Dexmedetomidine as an Adjuvant Analgesic in Intractable Graft versus Host Disease Pain in a Patient taking Buprenorphine

 

Background:

Dexmedetomidine is an alpha-2 receptor agonist

Used for sedation and analgesia

Decreases pain intensity and opioid consumption with minimal respiratory depression1,2

Previous literature describes dexmedetomidine as an analgesic adjuvant in acute pain states3,4

Less known regarding utility in chronic pain states 

Buprenorphine is a semisynthetic partial mu opioid agonist and kappa opioid antagonist

Used for patient with chronic pain states or as an opioid replacement therapy

Buprenorphine may cause opioids to be ineffective

Acute pain can be difficult to treat in patients on maintenance Buprenorphine

 

Case Report:

35 year old male  with a history of chronic myeloid leukemia status post bone marrow transplant, chronic pain and previous severe opioid addiction

Admitted with intractable pain secondary to graft versus host disease-induced

Maintained on buprenorphine-naloxone as an outpatient

Endorsed diffuse myalgias

Pain score of 10/10

Multi-modal analgesic regimen with ketamine

Continued uncontrolled pain

Dexmedetomidine infusion initiated

Pain promptly decreased to 6/10

Over 3 days, ketamine and dexmedetomidine were titrated down

Returned to outpatient pain regimen, discharge on day 9

 

Discussion:

Dexmedetomidine is an effective analgesic adjuvant

Average pain score prior to initiation of dexmedetomidine 8.14

Average pain score after initiation of dexmedetomidine 6.00

 Useful when opioids are contraindicated or ineffective

Conclusions:

Dexmedetomidine was effective as an adjuvant analgesic  in a patient on buprenorphine-naloxone

This report supports the use of dexmedetomidine as a component of multi-modal analgesic therapy for intractable pain states when other analgesic therapies may be limited

 

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