Non-opioid IV adjuvants in the perioperative period: Pharmacological and clinical aspects of ketamine and gabapentinoids

Untreated acute postoperative pain can transform into chronic pain that may have major negative effects on the individual's quality of life. It can also prolong recovery, rehabilitation and length of hospital stay, thus affecting societal economic burden. Given the multiplicity of mechanisms involved in postoperative pain, a multimodal analgesia regimen, using a combination of opioids and multiple agents aiming to augment their effects via different routes of administration, is a pharmacologically appropriate approach. This polypharmacological application provides superior pain relief at rest and after movement, reduced opioid consumption associated with reduced analgesic-related adverse effects, and better chances to prevent the induction of later hyperalgesia. The most important adjuncts currently employed are ketamine and gabapentinoids. They have been shown to help in reaching the desired effect when administered at drug-specific modes and at proven effective dosing throughout the perioperative period. (c) 2012 Published by Elsevier Ltd.