Non-opioid Analgesics from Small Group

Question 1

What are the NSAIDS we discussed? some toxicity about each?

Answer 1

Acetaminophen =20-30% opioid sparing; liver damage at high doses

Non-selective COX1/2 Inibitors = 30-50% opioid sparing and decreased opioid-associated PONV, but has GI effects, bone healing, hypersensitivity, asthma, renal insufficiency, and bleeding

Coxibs = COX2 selective but increased incidence of thrombus/stroke/MI

Question 2

What is Gabapentin? How dies it work? Effects?

Answer 2

Binds to **Voltage sensitive calcium channels **

20-62% opioid sparing effect

**Decreases vomiting, pruritis, and urinary retention from opioids **

Effects - Somnolence, dizziness, HA, balance problems, Peripheral edema, sweating, dry mouth, N/V

Question 3

What is Pregabalin? How does it work?

Answer 3

Binds to **Voltage-sensitive Ca channels **

25-30% opioid sparing effect but unclear if decreased opioid-related adverse effects

Effects: somnolence, dizziness, visual disturbances

Question 4

Ketamine as an analgesic: mechanism, opioid-sparing effects, side effects, uses

Answer 4

NMDA receptor antagonist

30-5% opioid sparing effects - unclear if decreased related adverse effects

Used in low doses for chronic pain management

Side Effects: Dysphoria, Hallucination, vivid unpleasant dreams, dizziness, blurred vision etc BUT all are UNLIKELY at LOW doses for which is is used for chronic pain management

Question 5

What is Clonidine and how is it used? EffectS?

Answer 5

Centrally actiing Alpha-2 agonist

25% opioid sparing effect and decreases Nausea associated with opioids

Side Effects: Intra-op and post-op Hypotension

Question 6

What is Dexmedetimidine? How does it work/what does it do? Effects?

Answer 6

Centrally acting Alpha2 Agonist

30% opioid sparing effect and decreases Nausea and Itching associated with opioids

Side Effects: Intra-op and Post-op **Bradycardia **

Question 7

How is dexamethasone used in pain management? What can it cause?

Answer 7

Glucocorticoid used and has 10% opioid sparing effect

Decreases PONV assoc with opioids

GOOD FOR BONE PAIN especially with Metastases!!!

Side Effects: Mild hyperglycemia, impaired wound healing and increased infection (although unlikely with single dose)