(Table 56-6: Adult Dosing Guidelines for Nonopioid Analgesics). Nonsteroidal anti-inflammatory drugs (NSAIDs) have been proven effective in the treatment of postoperative pain. In addition, they are opioid sparing and can significantly decrease the incidence of opioid-related side effects such as postoperative nausea and vomiting and sedation. Platelet dysfunction, GI ulceration, and an increased risk of nephrotoxicity are several reasons why the nonselective NSAIDs may be avoided in the perioperative period.

1. NMDA receptor antagonists (ketamine, dextromethorphan) may be analgesic adjuncts.
2. α₂-Adrenergic agonists (clonidine, dexmedetomidine) may be administered perioperatively to provide analgesia, sedation, and anxiolysis.
3. Gabapentin and pregabalin are effective analgesics not only for the treatment of neuropathic pain syndromes but also for the treatment of postoperative pain. When these drugs are combined with an NSAID, the combination has been shown to be synergistic in attenuating the hyperalgesia associated with peripheral inflammation.
4. Lidocaine has been shown to be analgesic, antihyperalgesic, and anti-inflammatory after IV administration.
5. Glucocorticoids possess analgesic, anti-inflammatory, and antiemetic effects.

Acute Pain Management

1. Acute Pain Defined
2. Anatomy of Acute Pain
3. Pain Processing
4. Chemical Mediators of Transduction and Transmission
5. The Surgical Stress Response
6. Preemptive Analgesia
7. Strategies for Acute Pain Management
8. Assessment of Acute Pain
9. Opioid Analgesics
10. Nonopioid Analgesic Adjuncts
11. Methods of Analgesia
12. Continuous Peripheral Nerve Blockade Caveats
13. Complications from Regional Anesthesia
14. Perioperative Pain Management of Opioid-Dependent Patients
15. Organization of Perioperative Pain Management Services
16. Special Considerations in the Perioperative Pain Management of Children