Useful adjuvants for postoperative pain management.
Adjuvants are compounds which by themselves have undesirable side-effects or low potency but in combination with opioids allow a reduction of narcotic dosing for postoperative pain control. Adjuvants are needed for postoperative pain management due to side-effects of opioid analgesics, which hinder recovery, especially in the increasingly utilized ambulatory surgical procedures. NMDA antagonists have psychomimetic side-effects at high doses, but at moderate doses do not cause stereotypic behavior but allow reduction in opioid dose to obtain better pain control. Alpha-2 adrenergic agonists cause sedation, hypotension and bradycardia at moderate doses, but at low doses can be opioid sparing especially in spinal administration. Gabapentin-like compounds have low potency against acute pain, but in combination with opioids allow a reduction in opioid dose with improved analgesia. Corticosteroids may have only a limited role as adjuvants while acetylcholine esterase inhibitors may have too many side-effects. Newer adjuvants will be needed to reduce opioid dose and concomitant side-effects, even more as same day surgeries become more routine.
Buvanendran
Asokumar
A
Department of Anesthesiology, 1653 W Congress Parkway, # 739, Rush University Medical Center, Chicago, IL 60612, USA. asokumar@aol.com
Kroin
Jeffrey S
JS
D000588:Amines / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use; D009388:Neostigmine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018691:Excitatory Amino Acid Antagonists; D016194:Receptors, N-Methyl-D-Aspartate; D009388:Neostigmine; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin; D003907:Dexamethasone; D003000:Clonidine