Multimodal Analgesia: Role of Non Opioid Analgesics
May L.Chin, M.D.
Professor of Anesthesiology and Critical Care Medicine
George Washington University Medical Center
Washington, District of Columbia
An optimal perioperative experience encompasses effective pain control with minimal side effects from anesthetic and analgesic drugs. The goals are to facilitate recovery of the surgical patient, enhance patient satisfaction and improve cost effectiveness. Despite these intentions, national surveys on postoperative pain management in the United States and in Europe report suboptimal pain control as well as significant adverse effects from opioid analgesia.1-3
Opioids have traditionally been the cornerstone for pharmacotherapy in the management of postoperative pain. However we are often faced with situations where monotherapy using opioid alone is inadequate. A multimodal approach to pain control, or balanced analgesia, is not a new concept. Treatment strategies which include a combination of analgesic options such as regional techniques and non opioid analgesics have shown improved analgesia, early mobilization and reduced opioid side effects in postoperative patients.4-6
Significant strides have been made toward understanding pain mechanisms which lead to sensitization of the nervous system and hyperalgesia. These mechanisms are more effectively targeted by analgesics other than opioids, such as NMDA antagonists, anticonvulsants, nonsteroidal anti-inflammatory agents, local anesthetics, and alpha 2 agonists. The use of these agents in a multimodal approach to optimize postoperative pain control will be discussed.
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