title: Psychiatric agents and implications for perioperative analgesia.
abstract: The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose-response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. Electronic address: bcatal@lsuhsc.edu.
authors.forename: Blas
authors.initials: B
authors.lastname: Catalani
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. Electronic address: chami3@lsuhsc.edu.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Hamilton
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. Electronic address: eherr1@lsuhsc.edu.
authors.forename: Edwin W
authors.initials: EW
authors.lastname: Herron
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: urmanr@gmail.com.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. Electronic address: cfox1@lsuhsc.edu.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. Electronic address: alankaye44@hotmail.com.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
mesh_terms: D000698:Analgesia / Q000379:methods*; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011619:Psychotropic Drugs
chemical_list: D011619:Psychotropic Drugs
keywords: adult; analgesic agents; analgesic drugs; analgesics; anorexic drugs; anorexigenic drugs; anticonvulsants; antidepressive agents; antidepressive agents, tricyclic; antipsychotic drugs; anxiolytics; barbiturates; benzodiazepines; buspirone; central stimulants; lithium carbonate; monoamine oxidase inhibitors; neuroleptanalgesia; neuroleptic drugs; neurotransmitter uptake inhibitors; pain; perioperative care; perioperative period; psychotropic drugs; serotonin uptake inhibitors