Surgical & Healthcare Alliance for enhanced Recovery & Pain Management (SHARP) Six Part Mini-Lecture Series-CME Paid Option-Multimodal Analgesia

Video Transcription

Video Summary

This lecture reviews the rationale and key pharmacologic options for perioperative multimodal analgesia to improve postoperative pain, reduce complications, speed recovery, and decrease opioid use, as emphasized in Enhanced Recovery After Surgery (ERAS) pathways. It highlights common non-opioid adjuvants: NSAIDs (including COX-2–selective agents) and acetaminophen, often started preoperatively and continued postoperatively, with attention to dosing and risks (GI bleeding, cardiovascular events, renal dysfunction, wound/anastomotic issues, and contraindications such as recent MI/CABG). Acetaminophen is effective, low-cost, and generally preferred orally; hepatotoxicity risk guides dosing in liver disease. Gabapentinoids (gabapentin/pregabalin) are discussed as frequently encountered but not routinely recommended perioperatively due to limited benefit and increased sedation/respiratory risk, especially with opioids; FDA warnings are noted. Alpha-2 agonists (dexmedetomidine, clonidine, tizanidine) can reduce opioids and nausea but may cause hypotension/bradycardia (less so with tizanidine). The lecture briefly covers tapentadol and tramadol and gives an example opioid plan for total joint arthroplasty, integrating non-opioid strategies.

Keywords

perioperative multimodal analgesia

Enhanced Recovery After Surgery (ERAS) pathways

NSAIDs and COX-2 inhibitors

acetaminophen dosing and hepatotoxicity risk

gabapentinoids (gabapentin/pregabalin) perioperative safety

alpha-2 agonists (dexmedetomidine/clonidine/tizanidine) opioid-sparing