Clinical application of perioperative multimodal analgesia.
The experience of intense postoperative pain remains a significant problem in perioperative medicine. The mainstay of postoperative analgetic therapy is the combination of nonopioid agents (e.g. paracetamol and NSAIDs) with strong opioids (e.g. morphine) according to the WHO analgesic ladder. But as the incidence and intensity of postoperative pain remains high, the search for and evaluation of additional concepts is ongoing. This review highlights the current trends of perioperative multimodal analgesia concepts.



Gabapentinoids, ketamine, dexamethasone and magnesium are effective parts of a multimodal analgesia concept without absolute contraindications and nearly without major negative side effects. Recent publications further define the role of these substances for perioperative use in terms of optimal dosing, positive side effects, relative potency and interaction.



Components of well tolerated and simple advanced multimodal analgesia concepts in the perioperative period are now easy to apply and ready to become a standard in the daily clinical practice.
Department of Anesthesiology, Radboud UMC, Nijmegen, The Netherlands.
Jörgen
J
Bruhn
Gert J
GJ
Scheffer
Geert-Jan
GJ
van Geffen
D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use; D008274:Magnesium / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin; D003907:Dexamethasone; D008274:Magnesium