TY - CHAP M1 - Book, Section TI - Chapter 161. Other Adjuvant Agents Commonly Used in Pain Management A1 - Voiculescu, Lucia Daiana A1 - Poonia, Amit A2 - Atchabahian, Arthur A2 - Gupta, Ruchir Y1 - 2013 N1 - T2 - The Anesthesia Guide AB - Table Graphic Jump Location|Download (.pdf)|PrintVarious Adjuvant Agents Used for Pain ManagementDrug/principal mechanism of actionPain indicationsCommon dosing1Common side effectsSpecial considerationsTramadolDual mechanism: serotonin/norepinephrine reuptake inhibitionWeak mu-opioid receptor agonismAcute and chronic pain: moderate–severe1Postoperative pain2Neuropathic pain250–100 mg po q6–8 hNausea, vomiting, constipation, dizziness, headachesSerious reactions: seizures, serotonin syndromeCaution if history/risk of seizureAvoid abrupt cessationRisk of suicidalityPregnancy Class CClonidineCentral alpha-2 adrenergic agonistPeripheral neuropathy2Postherpetic neuralgia2Cancer pain2CRPS2Postoperative pain2Adjuvant in neuraxial and peripheral nerve blocks2Opioid withdrawal20.1 mg po q12 h weekly titration up to 2.4 mg/day0.1 mg/day transdermalUp to 0.6 mg/day30 μg/h epidural infusionHypotension, bradycardia, AV block, dry mouth, drowsiness, sedation fatigue, depression, feverAvoid abrupt withdrawal, risk of rebound hypertensionPregnancy Class CKetamineNMDA receptor antagonismIntraoperative and postoperative pain2Burn pain2Cancer pain2Neuropathic pain2Opioid-induced hyperalgesia2IV infusionTransdermalSQ infusionIn analgesic doses: hypersalivation, anorexia, nausea, elevated BP, hallucinations, withdrawal syndrome (long-term use)Black box warnings: emergence reactions—various degrees of psychologic manifestations from pleasant dream-like states to irrational behavior and emergence delirium. The 100 mg/mL concentration of ketamine hydrochloride injection should not be injected intravenously without proper dilutionPregnancy Class DLidocaineBlocks sodium channelsDecreases ionic flux through the neuronal membranePostherpetic neuralgia1Local anesthesia, postoperative pain1Neuropathic pain2Burn pain2Topical: transdermalmaximum three patches/ 24 hIV: various protocolsPregnancy Class C1FDA approved.2Off-label usage for neuropathic pain. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=57263108 ER -