Multimodal therapy in perioperative analgesia

Karina Gritsenko; Yury Khelemsky; Alan David Kaye; Nalini Vadivelu; Richard D Urman

doi:10.1016/j.bpa.2014.03.001

Multimodal therapy in perioperative analgesia

Best Pract Res Clin Anaesthesiol. 2014 Mar;28(1):59-79. doi: 10.1016/j.bpa.2014.03.001. Epub 2014 Mar 15.

Authors

Karina Gritsenko¹, Yury Khelemsky², Alan David Kaye³, Nalini Vadivelu⁴, Richard D Urman⁵

Affiliations

¹ Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, NY, USA; Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, NY, USA; Acute Pain, Regional, Chronic Pain, Montefiore Medical Center, Bronx, New York, NY, USA; Albert Einstein College of Medicine, Yeshiva University, Montefiore Medical Center, Bronx, New York, NY, USA. Electronic address: karina.gritsenko@gmail.com.
² Anesthesiology, Icahn School of Medicine of Mount Sinai, New York, NY, USA; Pain Medicine Fellowship Program, Icahn School of Medicine of Mount Sinai, New York, NY, USA.
³ Department of Anesthesiology, LSU School of Medicine, New Orleans, LA, USA; Interventional Pain Services, LSU School of Medicine, New Orleans, LA, USA; Department of Pharmacology, LSU School of Medicine, New Orleans, LA, USA; Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA, USA; Department of Pharmacology, Tulane School of Medicine, New Orleans, LA, USA.
⁴ Anesthesiology Department, Yale University School of Medicine, New Haven, CT, USA.
⁵ Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Brigham and Women's Hospital, USA.

PMID: 24815967
DOI: 10.1016/j.bpa.2014.03.001

Abstract

This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.

Keywords: acute pain; adjuvant medication; balanced anesthesia; chronic postoperative pain; multimodal perioperative analgesia; persistent postoperative pain; postoperative pain; regional anesthesia.

Published by Elsevier Ltd.

Publication types

Review

MeSH terms

Analgesia / methods*
Analgesics / administration & dosage*
Drug Therapy, Combination
Humans
Pain, Postoperative / drug therapy*
Patient Satisfaction
Perioperative Care / methods

Substances

Analgesics