Use of Dexmedetomidine for Postoperative Pain Management Following Spine Fusion Surgery in a Highly Opioid-Tolerant Patient.

A 51-year-old man with metastatic renal cell carcinoma whose fentanyl requirement was 3000-4000 µg/h in inpatient hospice presented for a thoracic (T) vertebral 4-10 posterior spinal fusion for a lytic T7 compression fracture. He underwent total intravenous (IV) anesthesia with propofol, remifentanil, and ketamine; liposome bupivacaine was locally infiltrated at the end of the case. Following extubation on postoperative day (POD) 1, he had severe pain refractory to high-dose IV fentanyl patient control analgesia and ketamine infusion. His pain dramatically improved after a dexmedetomidine infusion was added and titrated to the analgesic effect. He participated in neurological examinations and fulfilled both surgical and pain management goals without side effects. Dexmedetomidine was successfully weaned off on POD 3.