ing within five to 10 minutes, according to Ronen Shechter, MD,
an assistant professor of anesthesiology at Johns Hopkins
University in Baltimore and co-medical director of its
Perioperative Pain Program (PPP). "It's faster to use, especially in
quick turnover places, where you want to know the pain is con-
trolled so patients can be discharged," he says. "The problem is
it's significantly more expensive than the pills."
• Ketamine. Dr. Schechter says this old anti-inflammatory drug
has been shown to reduce opioid consumption by 30% to 45%. "It
acts on many receptors, many locations, and is very effective,"
says Dr. Schechter, who uses it frequently in inpatient surgeries.
"It can reverse some of the side effects of opioids, like hyperalge-
sia. Patients wake up very nicely with it." It might not be ideal for
outpatient centers craving quick turnover, though. "If it's used too
long or too much, the patient may have lingering sedation," says
Dr. Schechter, characterizing it as a drug that should be employed
for very painful procedures or for patients with high opioid toler-
ance.
• IV lidocaine. Another medication commonly used in inpatient
procedures, this also has sedative properties. "It's very effective
as an analgesic, but the recovery is much slower," says Dr.
Schechter. "Because of that, I'm not too confident it would be a
great choice for outpatient settings."
• IV magnesium. This salt is an analgesic that Dr. Schechter
says has been shown to effectively reduce opioid requirements.
• Dexmedetomidine. Often used to prevent PONV, steroids like
this, applied at higher doses, have been linked to reduced use of
opioids. Dr. Schechter cautions their side effects, such as hyper-
glycemia and impaired wound healing, should be considered.
Dexmedetomidine, which has been used as a sedative and anal-
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