Recent advances in nonopioid analgesics for acute pain management

Nonopioid analgesics are compounds which by themselves have undesirable side effects or low potency, but in combination with opioids allow a reduction of narcotic dosing for postoperative pain control. Nonopioid analgesics are needed for postoperative pain management due to side effects of opioid analgesics, which hinder recovery, especially with the increased utilization of ambulatory surgical procedures. Of great benefit are the NSAIDs and the COX-2 inhibitors, which lead to about 30% to 40% reduction in opioid use for postoperative pain relief. NMDA antagonists have psychomimetic side effects at high doses, but at moderate doses do not cause stereotypic behavior but allow reduction in opioid dose to obtain better pain control. Alpha-2 adrenergic agonists cause sedation, hypotension, and bradycardia at moderate doses, but at low doses can be opioid-sparing, especially in spinal administration. Gabapentin-like compounds have low potency against acute pain, but in combination with opioids allow a reduction in opioid dose with improved analgesia.