University of Nebraska Medical Center, USA
Inadequate perioperative pain control delays postoperative mobilization, and may lead to development of chronic postoperative pain, amplified cardiac and pulmonary complications, and increased morbidity and mortality.1 Even though opioids are still widely used,2 more information on their misuse, limitations and side-effects is becoming available, including risk of dependence and opioid-induced hyperalgesia (OIH).3 Multimodal analgesia has been defined as the use of two or more analgesics or techniques that target different mechanisms or pathways in the nociceptive system.4 As drugs are combined, lower doses of each class can be given, thereby lowering the side effects of each individual drug, but increasing overall efficacy.5,6 Drugs commonly used in this framework include acetaminophen, non-steroidal anti-inflammatory drugs (NSAID) or cyclo-oxygenase-2 inhibitors, dexamethasone, gabapentin, clonidine, dexmedetomidine, intravenous lidocaine, magnesium and ketamine. When timed correctly, however, regional anesthesia remains the best and most powerful opioid-sparing technique for many indications.
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