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Correspondence  |   October 2003
Use of Anesthesia-assisted Detoxification in the Opioid-dependent Pain Patient
Author Affiliations & Notes
  • Christa Breitfeld, M.D.
    *
  • *Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
Article Information
Correspondence
Correspondence   |   October 2003
Use of Anesthesia-assisted Detoxification in the Opioid-dependent Pain Patient
Anesthesiology 10 2003, Vol.99, 1030. doi:
Anesthesiology 10 2003, Vol.99, 1030. doi:
In Reply:—
We appreciate Dr. Gourlay's interest in our work. 1 Of course, we are aware that clonidine, while diminishing sympathetic neural outflow both in volunteers 2 and in opioid addicts, 3,4 acts as an agonist on central α-receptors. We apologize for the typographical error that appears on page 571 of the original article.
We agree that antagonist supported detoxification from opioids during general anesthesia can restore opioid sensitivity. Accordingly, opioid receptor blockade, e.g.  , by oral naltrexone, should be maintained in formerly addicted patients as long as possible to prevent both relapses as well as potentially fatal effects of further opioid intake. However, our patient experienced chronic pain with tolerance to the analgetic effects of administered opioids. Thus, antagonist supported detoxification was intended to restore opioid sensitivity, allowing continuation of analgesic therapy by administration of much lower opioid dosages while again achieving sufficient analgesia.
With respect to cost–benefit ratios, we expect by this procedure high rates of successful detoxification with markedly shortened hospitalization. 5,6 Accordingly, this procedure seems to be economically attractive. However, a decrease in the number of relapses may not be expected, although little data are currently available.
References
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Muzi M, Goff DR, Kampine JP, Roerig DL, Ebert TJ: Clonidine reduces sympathetic activity but maintains baroreflex responses in normotensive humans. A nesthesiology 1992; 77: 864–71Muzi, M Goff, DR Kampine, JP Roerig, DL Ebert, TJ
Kienbaum P, Heuter T, Michel MC, Scherbaum N, Gastpar M, Peters J: Chronic mu-opioid receptor stimulation in humans decreases muscle sympathetic nerve activity. Circulation 2001; 103: 850–5Kienbaum, P Heuter, T Michel, MC Scherbaum, N Gastpar, M Peters, J
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