RT Book, Section
A1 Voiculescu, Lucia Daiana
A1 Poonia, Amit
A2 Atchabahian, Arthur
A2 Gupta, Ruchir
SR Print(0)
ID 57263108
T1 Chapter 161. Other Adjuvant Agents Commonly Used in Pain Management
T2 The Anesthesia Guide
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-176049-2
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57263108
RD 2024/04/19
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.