Kaye, but should not be sent in alone to battle pain. He instead says
you should tap into the pain-relieving potential of these commonly
used medications, which commonly serve as the basis for periopera-
tive cocktails:
• Ketamine has gained a resurgence as an opioid adjunct after it
was shown to be an effective agonist of NMDA receptors, which play
an important role in amplifying pain sensations. Research has shown
ketamine's positive effect on patients with chronic pain and opioid
dependency.
• Gabapentin and pregabalin inhibit channels in the central
nervous system that are upregulated during surgery and shut down
excitatory neurotransmitters in the central nervous system. These
drugs have been shown to be effective parts of opioid-sparing med-
ication regimens, especially in patients who are expected to expe-
rience severe post-op pain, and should be administered at least 2
hours before surgery to reach maximum effect. An important
warning: Large doses of gabapentin can cause respiratory depres-
sion and should be avoided.
• Alpha-2 agonists possess pharmacological properties — seda-
tion, hypnosis, anxiolysis, sympatholysis and analgesia — that make
them useful agents of a multimodal pain regimen. Clonidine and
dexmedetomidine have been shown to reduce opioid consumption
after surgery. Another warning: Both drugs have a negative effect on
blood flow, and can cause bradycardia and hypotension.
• IV lidocaine has analgesic, antihyperalgesic and anti-inflammato-
ry properties, and has been shown to help manage pain, shorten post-
op stays, improve bowel function and lower PONV rates in abdominal
surgery patients.
• IV NSAIDs and acetaminophen decrease the release of proin-
flammatory and pain-augmenting mediators at peripheral nerve sites.
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