Abstract

MUGABURE-BUJEDO, B. et al. Farmacologic adyuvants with saving effect of opioids in the perioperative period. Rev. Soc. Esp. Dolor [online]. 2018, vol.25, n.5, pp.278-290. ISSN 1134-8046.  https://dx.doi.org/10.20986/resed.2018.3663/2018.

In the last 15 years, the interest in the postoperative recovery and rehabilitation pathways (ERAS) has increased since both doctors and managers have analyzed the times of surgical recovery and intrahospital statistics. Although the approach to reduce the length of hospital stay is multifactorial and includes management objectives for various parameters such as hemodynamics, fluid administration, ventilation, feeding, intestinal motility and early mobility, the management of postoperative pain should be an area of basic importance. Opioids are widely known to have a side effect profile that slows down hospital recovery, delaying both hospital discharge and return to functional normalcy. These side effects include decreased bowel motility, ileus, postoperative nausea and vomiting, sedation and delirium. In addition, an association has been suggested between the administration of opioids and the recurrence of cancer in the surgical oncology population, specifically breast and prostate cancer. Anesthesiologists are well positioned to influence the success of ERAS protocols for adequate pain control, having many tools at their disposal to provide opioid preservation or even free of them during the perioperative period.

This review summarizes the available evidence on pharmacological therapies to achieve a saving of perioperative opioids, except anti-inflammatories that have a proven effect in this field, and supports the use of dexmedetomidine, clonidine, ketamine, pregabalin, lidocaine, magnesium and esmolol as non opioid adjuvants as agents within multimodal programs for the treatment of postoperative pain Despite this, additional tests are needed to elucidate the optimal combinations of these adjuvants.

Keywords : Opioid free analgesia; postoperative pain; postoperative recovery; dexmedetomidine; clonidine; ketamine; pregabalin; lidocaine; magnesium; esmolol.

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