The use of opioid adjuvants in perioperative multimodal analgesia

Postoperative analgesia plays a crucial role in day-case surgery. Patients expect effective pain relief after surgery, without side effects, and this may not always be possible when more complicated procedures are performed in ambulatory settings. Moreover, both surgeons and patients expect anaesthesiologists to provide an effective pain treatment service especially after ambulatory surgery, even in private practice settings. The protocols based on intravenous opioids or central neuraxial blockade are no longer appropriate, when a short, uncomplicated postoperative course is anticipated. Multimodal analgesia, combining different groups of analgesics, both opioid and non-opioid, with different mechanisms of action, and targets in central and peripheral nervous systems with minimal side effects may be an answer. In this review, we present and discuss the current status of knowledge, with special reference to the role of adjuvants to opioids in acute postoperative pain.