Perioperative Challenges of Heroin Addiction: A Case Report of Opioid-Free Anesthesia in Tongue Carcinoma Excision With Free-Flap Reconstruction

Anesthesia for major head and neck surgery is historically heavily reliant on opioids with deleterious consequences. We reported a case of patient history heroin abuse submitted to tongue carcinoma excision, followed by free-flap reconstruction under opioid-free anesthesia. used propofol total intravenous anesthesia perfusions ketamine, dexmedetomidine, lidocaine, magnesium sulfate analgesia, complemented boluses dexamethasone, acetaminophen, parecoxib, metamizole. Hemodynamic needs the procedure were addressed titrating sodium nitroprusside or dobutamine. The was weaned from ventilator at end surgery. Surgical outcomes achieved analgesia allowed early reestablishment bodily functions without compromise adequate pain control. protocols still lack scientific evidence, especially in context substance abuse: opioid-sparing approaches seem viable option, which requires further studies familiarity health care professionals.