Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery.

Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery.

Publication date: Dec 01, 2019

The present review aims to propose pharmacological strategies to enhance current clinical practices for analgesia in ambulatory surgical settings and in the context of the opioid epidemic.

Each year, a high volume of patients undergoes ambulatory surgery worldwide. The multimodal analgesia proposed to ambulatory patients must provide the best analgesic effect and patient satisfaction while respecting the rules of safety for ambulatory surgery. The role of nurses, anesthesiologists, and surgeons around said surgery is to relieve suffering, achieve early mobilization and patient satisfaction, and reduce duration of stay in hospital. Currently, and particularly in North America, overprescription of opioids has reached a critical level constituting a ‘crisis’. Thus, we see the need to offer more optimal multimodal analgesia strategies to ambulatory patients.

These strategies must combine three key components when not contraindicated: regional/local analgesia, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Adjuvants such as gabapentinoids, N-methyl-D-aspartate receptor modulators, glucocorticoids, ?2-adrenergic receptor agonists, intravenous lidocaine might be added to the initial multimodal strategy, however, caution must be used regarding their side effects and risks of delaying recovery after ambulatory surgery. Weaker opioids (e.g. oxycodone, hydrocodone, tramadol) could be used rather than more powerful ones (e.g. morphine, hydromorphone, inhaled fentanyl, sufentanil). This, combined with education about postoperative weaning of opioids after surgery must be done in order to avoid long-term reliance of these drugs.

Richeb’e, P., , Brulotte, and Raft, J. Pharmacological strategies in multimodal analgesia for adults scheduled for ambulatory surgery. 04288. 2019 Curr Opin Anaesthesiol (32):6.

Concepts Keywords
Acetaminophen Surgery
Adjuvants Psychoactive drugs
Adrenergic Receptor Euphoriants
Ambulatory RTT
Analgesia Morphinans
Analgesic Phenols
Aspartate Opioids
Contraindicated Analgesic
Fentanyl Hydromorphone
Glucocorticoids Morphine
Hospital Fentanyl
Hydrocodone Tramadol
Hydromorphone
Intravenous
Lidocaine
Local Analgesia
Methyl
Morphine
Multimodal
Nonsteroidal
North America
NSAIDs
Opioid Epidemic
Opioids
Oxycodone
Pharmacological
Tramadol
Weaning

Semantics

Type Source Name
disease MESH satisfaction
disease MESH suffering
drug DRUGBANK Acetaminophen
drug DRUGBANK Lidocaine
drug DRUGBANK Oxycodone
drug DRUGBANK Hydrocodone
drug DRUGBANK Tramadol
drug DRUGBANK Morphine
drug DRUGBANK Hydromorphone
drug DRUGBANK Fentanyl
drug DRUGBANK Sufentanil
disease MESH weaning

Original Article

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