instruction: hello doctor I am undergoing major spinal deformity surgery next month anterior and posterior I am 50 years old and this is my fourth scoliosis surgery in recent years I have developed a sensitivity to morphine and I cannot take dilaudid hydromorphone because it gives me terrible headaches what other options are available to put into my spinal catheter for post operative pain control in the hospital I know that fentanyl is short acting and they do not use demerol any more in my place what can be done for me also I am currently on 50 my oxycodone per day and zohydro 80 my for pain so my tolerance for opiates has gone way up
output: hi from your brief history I can sense that you have already become tolerant to opioids once tolerance develops to one group of opioids simultaneously other opioids also develop the same way I would suggest the addition of clonidine dexmedetomidine through your spinal catheter since opioid tolerant patients do have good postoperative pain relief with this drug multimodal analgesic with intravenous ketorolac buprenorphine through the spinal route can be another option but I do not know whether your anesthesiologist is comfortable with these drugs kindly have a discussion with your physician