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Multimodal Analgesia, Current Concepts, and Acute Pain Considerations
Erik M Helander1, Bethany L Menard1, Chris M Harmon1
1Department of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Current Pain and Headache Reports
|January 30, 2017
Summary
Multimodal analgesia, combining various pain medications, is recommended for postoperative pain management. This approach targets pain via different pathways, potentially reducing side effects and opioid use.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Multimodal analgesia is recommended for postoperative pain management.
- It involves using drugs with different mechanisms of action for additive or synergistic effects.
- Agents include alpha 2 agonists, NMDA receptor antagonists, gabapentinoids, dexamethasone, NSAIDs, acetaminophen, and duloxetine.
Purpose of the Study:
- To review current evidence on various agents used in multimodal analgesia for postoperative pain.
- To highlight the benefits and limitations of each agent.
- To emphasize the importance of a multimodal approach in pain management.
Main Methods:
- Review of recent literature on pharmacological agents for multimodal analgesia.
- Analysis of studies on alpha 2 agonists, acetaminophen, gabapentinoids, ketamine, dexamethasone, and duloxetine.
- Evaluation of evidence for efficacy and side effects.
Main Results:
- Alpha 2 agonists offer opioid-sparing effects but can cause hypotension and bradycardia.
- Evidence for intravenous versus oral acetaminophen is inconclusive in certain patient groups.
- Gabapentinoid studies show mixed results, requiring further research.
- Ketamine, dexamethasone, and duloxetine show promise as adjuncts, but require more investigation.
- Multimodal analgesia can reduce side effects and target pain through diverse cellular pathways.
Conclusions:
- A multimodal analgesic approach is beneficial for managing postoperative pain.
- It allows for targeting pain through different cellular pathways, potentially reducing side effects.
- Continued research is needed for agents like gabapentinoids and duloxetine.
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