Anesthetic Management in Patients with Opioid Hypersensitivity Syndrome
DOI:
https://doi.org/10.36489/nursing.2025v30i329p11896-11919Keywords:
Opioid hypersensitivity, Opioid-free anesthesia, Opioid-induced hyperalgesia, Perioperative anaphylaxis, Multimodal analgesiaAbstract
Introduction: Opioid hypersensitivity represents an emerging challenge in modern anesthesiology, ranging from pseudoallergic reactions to severe intraoperative anaphylaxis. The growing need for safe and individualized protocols has driven the adoption of multimodal analgesia and opioid-free anesthesia strategies. Methods: A systematic review was conducted following PRISMA
2020 guidelines. Searches were performed in PubMed (Free full text, 2020–2025), including original studies, reviews, case reports, and clinical trials addressing anesthetic management of patients with opioid hypersensitivity, intolerance, or opioid-induced hyperalgesia. Results: From 303 initial records, 13 studies met the eligibility criteria, nine with direct applicability and four indirect. Evidence supports that opioid-free anesthesia (OFA) using dexmedetomidine, ketamine, intravenous lidocaine, and regional blocks provides effective and hemodynamically stable analgesia. Clinical reports highlighted the importance of detailed pre-anesthetic assessment, recognition of cross-reactivity, and immediate availability of advanced life support for perioperative anaphylaxis. Conclusion: The anesthetic management of patients with opioid hypersensitivity should rely on three key pillars: prevention, pharmacologic substitution, and individualized analgesia. Multimodal and opioid-free approaches reduce immunologic and nociceptive risks, enhancing perioperative safety and patient outcomes.
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Copyright (c) 2025 Maria Fernanda Mazi Finamore, Lana Paola Almeida Santos Lima, Mell Mazuco Jeremias, Caroline da Silva Cardoso, Felipe Felix de Almeida, Gabriel Ayres Ferreira, Heike Felipe Rangel Dias
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