Multimodal analgesia consists of using various modalities to reduce pain, thus providing more effective analgesia while reducing doses and side effects.
- Use regional techniques when possible:
- Nonopioid analgesics (see chapter 157)
- Opioid analgesics (see chapter 159):
- Adjuvant medications (see also Chapters 160 and 161):
Adjuvant Medications Used for Multimodal Analgesia
|Drug||Dosing||Common side effects||Comments|
|Gabapentin (Neurontin)||Start at 300 mg qhs, can be titrated to 2,400 mg per day divided in three doses||Dizziness, somnolence, peripheral edema||Adjust doses in patients with renal insufficiency. Doses should be tapered when discontinuing therapy|
|Pregabalin (Lyrica)||Start at 50 mg qhs, can be titrated to 300 mg per day divided three times daily||Confusion, dizziness, somnolence, edema, weight gain||Similar mechanism of action as gabapentin. Doses should be adjusted in patients with renal insufficiency. Doses should be tapered when discontinuing therapy|
|Ketamine||0.1–0.5 mg/kg/h IV||Hallucinations, vivid dreams, drowsiness||Especially useful in opioid-tolerant patients|
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