The Use of Thoracic Epidural for Rapid Opioid Taper

BACKGROUND: Inflammatory Bowel Disease (IBD) is often associated with significant abdominal pain that can be challenging to control. Although controversial, opioids are often prescribed for the management of abdominal pain in patients with IBD. There have been several methods described for the rapid taper of patients on long-term, high-dose opioids. However, to date, there have been no reported cases using epidural analgesia for rapid opioid taper. CASE REPORT: We present a case of a 36-year-old man with ulcerative colitis and recurrent bowel obstructions on a high-dose transdermal fentanyl patch whose opioid consumption was rapidly tapered during inpatient hospitalization utilizing thoracic epidural analgesia. CONCLUSION: The potential role of epidural analgesia in rapid opioid taper has yet to be explored. In patients with chronic pain and inflammatory bowel disease or recurrent bowel obstructions, epidural analgesia may be particularly helpful to improve gastrointestinal motility while also being used to rapidly taper opioid dosage. KEY WORDS: Inflammatory bowel disease, ulcerative colitis, Crohn’s disease, epidural, opioids, rapid opioid taper, fentanyl patch