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

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Video Summary

The lecture reviews non-opioid adjuvants for multimodal perioperative analgesia, focusing on newer and less commonly used options. Magnesium can be given as a bolus or infusion to blunt physiologic responses to noxious stimuli, but carries risks of hypotension/bradycardia and is contraindicated in heart block; prolonged use requires caution in renal impairment. IV lidocaine (sodium channel blocker with additional receptor effects) can reduce ileus, pain, opioid use, and length of stay; typical dosing is a bolus (~1.5 mg/kg) then infusion (1–3 mg/kg/hr intraop; 1–2 mg/kg/hr postop). Key concerns include hepatic disease, cardiac conditions, interactions with other local anesthetics, and signs of toxicity. Evidence does not show clear prevention of chronic postsurgical pain after breast surgery. Ketamine (NMDA antagonist) reduces pain and opioid needs, especially for high-pain/long procedures, but may cause psychotropic and cardiovascular effects and needs monitoring/tapering. Dextromethorphan is a less-used NMDA option. A novel agent, suzetrigine (NaV1.8 inhibitor), shows placebo benefit but similar pain control to hydrocodone/APAP in trials; interactions, cost, and longer-term safety remain questions. IV dexamethasone improves pain, function, and reduces opioids after arthroplasty with minimal short-term infection risk but may increase anastomotic leak risk. Muscle relaxant evidence is limited; cyclobenzaprine may be preferred, while baclofen is associated with higher opioid overdose risk.

Keywords

multimodal perioperative analgesia

magnesium infusion analgesic adjuvant

intravenous lidocaine infusion dosing and toxicity

ketamine NMDA antagonist perioperative pain

suzetrigine NaV1.8 inhibitor postoperative analgesia

dexamethasone perioperative analgesia and surgical risks