Multimodal Pain Management Paper

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Multimodal Pain Management Paper



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Multimodal Analgesia and Opioid Sparing Strategies - Enhanced Recovery after Surgery (ERAS®)

The release of these mediators, combined with increased nociceptor excitability, lead to hyperalgesia. Preemptive analgesia is defined as treatment that starts before surgery and prevents the establishment of central sensitization caused by incisional and inflammatory injury. It is administered before surgery—before the onset of noxious stimuli, and it may reduce the needed amount of anesthesia and postoperative analgesia. Challenges: Patients with chronic pain are already sensitized. So it may be harder to achieve successful preemptive analgesia in such patients.

Strategies for Implementing: Preemptive analgesia includes local anesthesia, nerve block, epidural block, subarachnoid block, IV analgesics, and ant-inflammatory drugs. This clinical practice guideline recommends nonsteroidal anti-inflammatory drugs NSAIDs , gabapentin or pregabalin, and ketamine. They inhibit prostaglandin synthesis by inhibiting cyclooxygenase-1 COX Celecoxib is a COX-2 inhibitor and celecoxib is minimally active at baseline.

It reduces pain by preventing inflammation, causing hyperalgesia and allodynia. Celecoxib mg PO minutes pre-operatively maintains platelet function, gastrointestinal mucosal integrity, and renal function. Gabapentin prevents the development of central excitability by stabilizing the neuronal membrane and decreasing the subcutaneous response to pain fiber signals. It is antihyperalgesic. In combination with NSAIDs, gabapentin causes a synergistic reduction in hyperalgesia associated with peripheral inflammation. Side effects are somnolence, dizziness, confusion, and ataxia. Since gabapentin is not metabolized, no significant toxicity occurs. Ketamine exerts preventative analgesic effects by modulating central sensitization and decreasing acute and chronic post-operative pain.

Stimulation of the NMDA receptor is involved in the development and maintenance of persistent postoperative pain, hypersensitivity, windup, allodynia, opioid-induced tolerance, and opioid-induced hyperalgesia. Much confusion and controversy surround the terms preemptive vs preventative analgesia. Analgesic strategies used in more extensive surgeries require interventions capable of preventing central sensitization throughout the perioperative period. Multimodal approaches that address multiple sites along the pain pathway may prove necessary to prevent central sensitization adequately. And pain control is scrutinized more closely by society and the government. We need more clinical studies to better understand and interrupt pain pathways in our efforts to help our patients in acute and chronic pain.

Rajpal S. Neuromodulators and Preemptive Analgesia. March , Las Vegas, NV. Can Patients Find You? List your practice in our directory. Register Now or Log In. Email Print. This page is best viewed with JavaScript enabled. Written by Maggie Schwarz. This activation, combined with persistent C-fiber activation, leads to hyperalgesia and allodynia. Perioperative Pain Management Traditional perioperative pain management consists of opioid medications, which target central mechanisms involved in pain perception. In multimodal analgesia , several agents act at different sites along the pain pathway.

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By using our site, you acknowledge that you have read and understand our Privacy Policy and Terms of Use. Share 1 Share Email. Home Medications Home Surgery. July 8, Explore further. More information: Joseph A. DOI: Provided by Wolters Kluwer Health. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only. Researchers develop breast cancer prediction tool for black women Oct 08, Oct 08, Related Stories. Knowledge gaps on opioid use after surgery offer opportunities for improving patient education May 13, Apr 06, Apr 28, HSS orthopedic surgeons address opioid epidemic head on Mar 12, Apr 26, Mar 12, Recommended for you.

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