Hickman. "We used to use it a lot more, but now we tend to give it
more orally and use the IV version in certain cases or as a rescue in
PACU."
More providers are also combining drugs traditionally used to treat
seizures, like gabapentin or pregabalin, with an NSAID to provide pre-
emptive analgesia, says Dr. Settles. "Especially in orthopedics, you'll
see that the night before or the day of surgery, providers will have the
patient take a little water and a combination of the 2, like gabapentin
and celecoxib," she says.
Steroids also play a role in these cocktails. Dr. Hickman notes that
there's a growing movement to inject the corticosteroid dexametha-
sone pre-operatively to ward off post-op inflammation and PONV.
5. Abuse-deterrent opioids
While opioids have received a bad rep lately, they still can play a
role in your treatment of surgical pain, says Dr. Settles. "[Opioids]
still have a place in multimodal pain management," she says. New
options — including Xartemis XR, an oxycodone and acetamino-
phen formula designed to release the opioid slowly — have been
specifically formulated to reduce abuse, according to the drugs'
manufacturers. The key is finding the right balance, which often
means limiting their use to treating breakthrough pain. "But you
have to individualize the approach," says Dr. Settles. "Every surgery
and patient is different. People try to make medicine an algorithm,
but you have to understand the patient and any comorbidities, and
tailor the medications to create the optimal plan."
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