Multimodal analgesia

From Ganfyd

Analgesia based upon the use of multiple analgesic drug classes or techniques to target different points in the neurological pathways relevant to pain perception. This strategy not only requires an understanding of pain physiology and pathophysiology so pharmacologic interventions can be tailored to meet the needs of the patient but should be backed up by good quality evidence of net efficacy as there is considerable complexity with the potential for unexpected drug or other interactions. It is a brave doctor who would generalise on the present evidence base. For example after abdominal hysterectomy there is little evidence that paracetamol, pregabalin and dexamethasone reduce morphine consumption and pain score compared with paracetamol alone but the dexamethasone reduced nausea which is an important distressing non-pain symptom^[1]. However gabapentin, a drug that should have similar pharmacological effects to pregabalin, did perioperively in abdominal hysterectomy, reduce morphine consumption^[2]. So the literature requires careful evaluation especially in the context that a number of fraudulent randomised controlled trials from one prominent researcher could have biased literature reviews in the fields of analgesia for orthopaedic operations up to March 2009^[3] and there are multiple factors that might prevent the actual delivery to patients of the regimes found effective in randomised controlled trials.

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