Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Multimodal analgesia for controlling acute postoperative pain

Buvanendran, Asokumar; Kroin, Jeffrey S

Current Opinion in Anaesthesiology: October 2009 - Volume 22 - Issue 5 - p 588–593
doi: 10.1097/ACO.0b013e328330373a
Pain medicine: Edited by Raymond Sinatra

Purpose of review Multimodal analgesia is needed for acute postoperative pain management due to adverse effects of opioid analgesics, which can impede recovery; a problem that is of increasing concern with the rapid increase in the number of ambulatory surgeries. Yet, the literature on multimodal analgesia often shows variable degrees of success, even with studies utilizing the same adjuvant medication.

Recent findings Nonsteroidal anti-inflammatory drugs and selective cyclooxygenase-2 inhibitors consistently reduce postoperative opioid consumption. The N-methyl-D-aspartate antagonists have produced variable results in studies, which may be due to the dose and timing of drug administration. Alpha-2 adrenergic agonists have been useful as adjuvant for regional analgesia but not when administered orally. The alpha-2-delta receptor modulators such as gabapentin have shown early promising results in multimodal analgesia. Local anesthetic injection at the surgical site, though not as a preemptive analgesic, has recently been demonstrated to be beneficial in multimodal analgesia. No new adjuvants have appeared in the last year, which robustly reduce opioid consumption and opioid-related adverse effects.

Summary There is a continuing need to explore new drug combinations to achieve all of the purported goals of multimodal anesthesia.

Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA

Correspondence to Dr Asokumar Buvanendran, MD, Department of Anesthesiology, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA Tel: +1 312 942 3685; fax: +1 312 942 8858; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.