Multimodal Opioid-Sparing Analgesia for Lumbar Decompression in a Patient With Opioid-Associated Sphincter of Oddi Symptoms: A Case Report.
- 1Anaesthesia, University Hospital Limerick, Limerick, IRL.
Abstract
Sphincter of Oddi symptoms can make perioperative analgesia challenging, particularly in patients who have previously developed severe biliary-type pain after opioid administration. We describe the perioperative management of a 51-year-old woman with a clinically diagnosed history of sphincter of Oddi dysfunction. During previous surgery, she reported developing severe right upper quadrant pain and nausea shortly after receiving opioids. She subsequently underwent approximately three hours of L4/5 lumbar decompression under general anaesthesia. An opioid-sparing multimodal analgesic regimen was used, including paracetamol, ibuprofen, tramadol, ketamine, intravenous lidocaine, clonidine, pregabalin, and local levobupivacaine infiltration. Fentanyl was given at induction, and remifentanil was used during the procedure. Postoperatively, regular tramadol was continued with pregabalin, clonidine, and a lidocaine patch. At 24 hours, pain was 4/10 at rest and increased to 8/10 during physiotherapy. By 48 hours, pain at rest was 4/10. She did not develop the right upper quadrant or biliary-type pain that she had previously experienced with opioids. She had nausea in the recovery area, which settled with standard antiemetic treatment. She mobilised successfully with physiotherapy and was satisfied with her pain management, stating that she would choose the same approach again. This case describes a practical opioid-sparing approach in a patient with a history of opioid-associated sphincter of Oddi symptoms. Although opioids could not be completely avoided, multimodal analgesia allowed their use to be limited while providing acceptable postoperative pain control.
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BibTeX
@article{cheema2026multimodal,
title = {{Multimodal Opioid-Sparing Analgesia for Lumbar Decompression in a Patient With Opioid-Associated Sphincter of Oddi Symptoms: A Case Report.}},
author = {Asad Shabbir Cheema},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116500},
url = {https://europepmc.org/article/MED/42894828},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multimodal Opioid-Sparing Analgesia for Lumbar Decompression in a Patient With Opioid-Associated Sphincter of Oddi Symptoms: A Case Report.
AU - Asad Shabbir Cheema
PY - 2026
DA - 2026/09/18
JO - Cureus
DO - 10.7759/cureus.116500
UR - https://europepmc.org/article/MED/42894828
AB - Sphincter of Oddi symptoms can make perioperative analgesia challenging, particularly in patients who have previously developed severe biliary-type pain after opioid administration. We describe the perioperative management of a 51-year-old woman with a clinically diagnosed history of sphincter of Oddi dysfunction. During previous surgery, she reported developing severe right upper quadrant pain and nausea shortly after receiving opioids. She subsequently underwent approximately three hours of L4/5 lumbar decompression under general anaesthesia. An opioid-sparing multimodal analgesic regimen was used, including paracetamol, ibuprofen, tramadol, ketamine, intravenous lidocaine, clonidine, pregabalin, and local levobupivacaine infiltration. Fentanyl was given at induction, and remifentanil was used during the procedure. Postoperatively, regular tramadol was continued with pregabalin, clonidine, and a lidocaine patch. At 24 hours, pain was 4/10 at rest and increased to 8/10 during physiotherapy. By 48 hours, pain at rest was 4/10. She did not develop the right upper quadrant or biliary-type pain that she had previously experienced with opioids. She had nausea in the recovery area, which settled with standard antiemetic treatment. She mobilised successfully with physiotherapy and was satisfied with her pain management, stating that she would choose the same approach again. This case describes a practical opioid-sparing approach in a patient with a history of opioid-associated sphincter of Oddi symptoms. Although opioids could not be completely avoided, multimodal analgesia allowed their use to be limited while providing acceptable postoperative pain control.
SN - 2168-8184
ER -