Opioid Withdrawal Precipitated

To the Editor:

Cancer patients can be among the most challenging groups in which to maintain pain control. At our institution, many cancer patients are managed with patient-controlled analgesia (PCA) opioids, sometimes on an outpatient basis. These patients frequently undergo multiple surgeries as well as courses of chemotherapy and radiotherapy and, as a result, often require multiple blood product transfusions. According to the American Association of Blood Banks standard,1 blood transfusions should not be co-administered with any intravenous drugs or fluids apart from 0.9% sodium chloride. For many cancer patients, it is difficult or impractical to establish additional intravenous access solely for blood product administration, and therefore, the practice at our institution has been to disconnect any current intravenous infusion for the duration of blood product transfusion. Here, we describe a case of severe opioid withdrawal after disconnection of intravenous hydromorphone PCA and initiation of a blood transfusion....