LOADING AWESOME
OPIOID ALTERNATIVES
PART ONE
www.propofology.com
Dr. Sergey Motov (USA)
Dr. David Lyness (UK/IRE)@Gas_Craic / @PainfreeED
Key concepts of the use of NON-OPIOIDS is key in acute pain.
NSAIDS, LIDOCAINE, METHOCARBAMOL, PARACETAMOL, KETAMINE, PROPOFOL, DEXMEDETOMIDINE, CLONIDINE, HALOPERIDOL, PROCHLORPERAZINE, TRIPTANS, TOPICAL CREAMS, PREGABALIN, GABAPENTIN, AMITRIPTYLINE AND MAGNESIUM
In all cases, active consideration of REGIONAL ANAESTHESIA must be given for all acute bony injuries, distal and proximal wounds and refractory headache. It is a standard of care, providing optimal pain relief.
You should consider the following drugs:
- The concept is termed CERTA (Channels/Enzymes/Receptors Targeted Analgesia)
- Based on our improved understanding of neurobiological aspect of pain
- Part of a multi-modal analgesic strategy - this is superior to single-agent options
- Shift from symptom-based approach to pain to a mechanistic approach
- Targeted, patient-focused analgesic approach = combinations of non-opioid analgesics = less opioids
- Synergistic combinations act on different target sites
- Resulting in greater analgesia, reduced dose of each individual medications
- This may lead to fewer side effects (particularly over-sedation) and shorter length of stay
CERTA Considerations
The use of these various medications rely on actions on various channels, enzymes and receptor sites.
CHANNELS - Sodium (Lidocaine) & Calcium (Magnesium & Pregabalin/Gabapentin)
ENZYMES - COX 1,2 & 3 (Paracetamol, Aspirin)
RECEPTORS - MOP/DOP/KOP (Opioids)
NMDA (Ketamine, Magnesium)
GABA (Pregabalin, Gabapentin, Sodium Valproate)
Alpha 1&2 (Tamsulosin = A1 | Haloperidol, Chlorpromazine, Dexmedetomidine & Clonidine = A2)
5HT1-4, (Haloperidol, Chlorpromazine, Ondansetron, Triptans, Metoclopramide)
D1-2 (Haloperidol, Chlorpromazine, Prochlorperazine = D2)
H1 (Chlorpromazine)
MULTI-MODAL ANALGESIA = BEST ANALGESIA
