Acute opioid withdrawal following the discontinuation of a short term epidural fentanyl infusion
Abstract
Acute opioid withdrawal has been described after interruption of prolonged intrathecal opioids but has
not been reported after discontinuation of epidural fentanyl. A 60 year old male underwent a Whipple
procedure and T7 thoracic epidural was placed for postoperative pain management using bupivacaine
0.1% with fentanyl 2 μg/ml started at a rate of 6 ml/hr. On the third postoperative day the epidural was
discontinued. The patient developed acute opioid withdrawal after four hours of discontinuation, to be
relieved by intravenous tramadol and fentanyl. The epidural infusion was resumed and tapered down
gradually over a period of 12 hrs with no recurrence of withdrawal symptoms.