The illicit use of the alpha-2 agonist animal tranquilizer xylazine ("tranq"), generally combined with fentanyl or heroin, has become an emerging health threat across the United States and Canada. We introduce a case showing the benefit of multidisciplinary management of a patient who presented for surgical management of xylazine-induced skin ulcers. In the perioperative period, maintenance of full-agonist opioids and alpha-2 agonists minimized the patient's withdrawal symptoms. A robust multimodal strategy, including the use of regional anesthesia catheters, when possible, helped limit opioid use in this highly tolerant patient while transitioning to long-term substance use treatment.
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