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Current Anesthesiology Reports

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01-09-2019 | Clonidine | Regional Anesthesia (P Kukreja, Section Editor)

Perioperative Multimodal Pain Management: an Evidence-Based Update

Authors: David W. Creighton, Amanda H. Kumar, Stuart A. Grant

Published in: Current Anesthesiology Reports | Issue 3/2019

Abstract

Purpose of review

The purpose of this article is to provide a concise review of recent updates and ongoing controversies in perioperative multimodal analgesia with a specific focus on systemic pharmacologic options.

Recent findings

Acetaminophen, non-steroidal anti-inflammatory drugs, and ketamine provide clear benefit for analgesia and opioid sparing, with wide safety margins at clinically relevant doses. Enthusiasm is waning for the use of gabapentinoids (gabapentin and pregabalin) and systemic alpha-2 agonists (clonidine and dexmedetomidine) due to small benefit and a potentially dangerous side effect profile (sedation). Lidocaine infusions may improve analgesia and reduce the risk of ileus, but current research quality is poor. Corticosteroids appear to improve pain control and spare opioids but, probably at greater doses than are typically used for nausea prophylaxis. There remains limited evidence for use of anticonvulsants, antidepressants, skeletal muscle relaxants, or cannabinoids but animal studies are promising, so more clinical trials are needed in humans. There is growing evidence for the routine use of non-pharmacologic pain management techniques like transcutaneous electrical nerve stimulation and cognitive behavioral therapy.

Summary

More high-quality clinical trials and systematic reviews are needed in several drug classes to assess the potential for benefit and risk of harm with respect to perioperative multimodal analgesia.

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Title: Perioperative Multimodal Pain Management: an Evidence-Based Update
Authors: David W. Creighton
Amanda H. Kumar
Stuart A. Grant
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Clonidine
Postoperative Pain Management
Paracetamol
Opioids
Opioids
Gabapentin
Ketamine
Published in: Current Anesthesiology Reports / Issue 3/2019
Electronic ISSN: 2167-6275
DOI: https://doi.org/10.1007/s40140-019-00340-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Perioperative Multimodal Pain Management: an Evidence-Based Update

Abstract

Purpose of review

Recent findings

Summary

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

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