Clinical experience with antagonist-induced opiate withdrawal under anaesthesia

FRANÇAIS :
Cet article décrit une expérience de sevrage aux opiacés provoqué par des antagonistes, sous anesthésie. 88 patients, tous usagers d'opiacés de longue date et en échec dans les traitements de sevrage habituels, ont été traités selon cette méthode. Après anesthésie au propofol, de la naloxone et de la naltrexone ont été administrées à chaque patient. L'observation clinique de 14 patients montre que le sevrage de la codéïne et de la méthadone peut être raccourci de 2 à 3 jours. La majorité des patients continuent à souffrir de symptômes de sevrage pendant quelques jours après la désintoxification, après quoi la plupart peuvent être suivis en hôpital de jour.
ENGLISH :
The study describes experience with antagonist-induced opiate withdrawal under anaesthesia in standard clinical conditions. The study was restricted to patients who had undergone failed withdrawal treatments with usual methods over the past months. The patients they were intubated, ventilated and anaesthetized with propofol for 6 hours. Shortly after induction of anaesthesia, naloxone and naltrexone were administred. A high amount of fluid was used to balance changes in water and electrolytes. After anaesthesia the patients were transferred back to the addiction ward and sedated with clonidine. Eighty-eight patients were treated. They were long-term opiate users. Preference was given to methadone-substituted patients who were unable to rid themselves of methadone. The first 14 patients were observed in detail : it was found that withdrawal from codeine and methadone can be shortened to approximately 2-3 days. Twelve patients showed significant symptoms on the days following anaesthesia. The majority of patients treated by this method will continue to suffer withdrawal symptoms for a few days after detoxification, after which time most can be treated in an outpatient setting. Taking into account all the 88 patients, five had to stay in hospital for a longer period (up to 2 weeks) because of a prolonged withdrawal syndrome.