In this episode, we define multimodal analgesia and give a brief introduction to the many agents that can be utilised. Opioids are a mainstay of treating post-surgical pain and the goal of multimodal analgesia is not to avoid opioids (termed opioid-sparing analgesia) but to reduce the negative side effects while providing adequate post-surgical pain.
The medications listed are those that are typically used in British Columbia, Canada and may differ from your regional practice. For example, we mention IV acetaminophen briefly, this is difficult to obtain in Canada (at least in British Columbia where we practice) although I am aware that it is quite cheap and widely used in other areas of the world.
Apologies for the hissing - we had technical difficulties with the recording equipment.
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References:
1. Stone AB, Iban YC, Zhong H, et al. B318 Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: a population-based study. Reg Anesth Pain Med. 2022;47(Suppl 1):A234-A235.
doi:10.1136/rapm-2022-ESRA.392
2. Rosenberger DC, Pogatzki-Zahn EM. Chronic post-surgical pain – update on incidence, risk factors and preventive treatment options. BJA Education. 2022;22(5):190-196. doi:10.1016/j.bjae.2021.11.008
3. Djaiani G, Silverton N, Fedorko L, et al. Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2016;124(2):362-368. doi:10.1097/ALN.0000000000000951
4. Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener-Kronish JP. Miller’s Anesthesia. 9th ed. Elsevier Inc.; 2020.
5. Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. McGraw Hill LCC.; 2022.
6. O’Neill A, Lirk P. Multimodal Analgesia. Anesthesiology Clinics. 2022;40(3):455-468. doi:10.1016/j.anclin.2022.04.002
7. Dunn LK, Durieux ME. Perioperative Use of Intravenous Lidocaine. Anesthesiology. 2017;126(4):729-737. doi:10.1097/ALN.0000000000001527
8. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-273. doi:10.1097/ALN.0b013e31823c1030
All research, scriptwriting and recording were done by Misa Gillis UBC MSI4 and Blake Birnie UBC Anesthesiology R3