NON OPIOID MANAGEMENT OF ACUTE POSTOPERATIVE PAIN

Abstract

evelopment of chronic postsurgical pain syndromes, hyperalgesia and immunomodulation are some particular concerns as theymay be related to opioid exposure, intertwined with patient characteristicsand other factors. Application of a multimodal approach, administration ofpreventive analgesia and paradigm shift in surgical techniques all mandate arevisit of evidence-based perioperative pain management. Inadequate treatment of postoperative pain continues to be an important clinicalproblem, not only leading to worse outcomes in the immediate postoperative period but also an increased risk for persistent postoperative pain. Multimodal pain management combines the use of different pharmacologic mechanisms of action and additive or synergistic effects, which work by acting at different sites within the central and peripheral nervous system .The goal is to provide optimal pain control, limit the amount of opioids required after surgery, and therefore, decrease their associated adverse effects. Pregabalin is a novel drug in which there has been heightened research interest with respect to its analgesic, sedative, anxiolytic and opioid-sparing effects in various pain settings, including postoperative pain. Its main advantage overgabapentin may be a faster onset and reduced adverse effects. As the recent ASA Task Force on Acute Pain Management guidelinesclearly emphasize a multimodal approach to analgesia in the perioperative setting, regional analgesia has a clear role in reducing postoperative pain in the PACU and should be used whenever possible. Regional analgesia has been demonstrated to be superior to opioids in the management of postoperative pain, especially in the orthopedic populations. Numerous perineural adjuvants have been used with local anesthetics in regional anesthesia in an attempt to optimize block characteristics and improve clinical outcomes such as: Vasoconstrictors, α2-Adrenergic Agonists, Dexamethasone, Ketamine, Magnesium sulphate and Midazolam. The ideal adjuvant that acts to prolong anesthesia and improve clinical outcomes while maintaining a favorable side effect profile, remains undiscovered. The useofultrasoundhasbecomeenormouslypopular within thecontextofregionalanesthesia.Eversinceits introductioninregionalanesthesia,anumberofarticleshave been publishedcontributingmodificationstotheclassic approachesthatdonotuseultrasoundasaguide. The field of pain management