Multimodal drug The biggest progress in controlling pain in the last 20 years coupled with the use of multimodal drugs and continuous infusion technique update. With multimodal approach to pain relief, a variety of agents, including local anesthetics, nonsteroidal antiinflammatory drugs, opioids, α2-adrenergic agonist, and N-methyl-D-aspartic acid receptor inhibitors in combination to maximize pain relief. The types of drugs that are active in pain receptors, peripheral nerves, spinal cord level, and the cerebral cortex. Additive and synergistic effects seen when morphine intrathecal (spinal) combined with clonidinc, norephinephrine, carbachol, or midazolam for animals used for experiments in the laboratory.
Antiinflamantori nonsteroidal medications is an effective analgesic, but may be contraindicated in certain conditions. Ketorolac and eliminating pain piroxan provide an excellent after several procedures, such as laparoscopy, arthroscopy, and even hip arthroplasty. However, for surgical procedures that have a result that may be jeopardized by hematoma formation, antiinflamantori nonsteroidal drugs are not given the recipe. Likewise, there are considerations about the risk of renal failure due to use of nonsteroidal antiinflamantori drugs in patients who have abnormal renal function peroperatif. In patients who undergo long-term therapy using nonsteroidal antiinflamantori drug, drug administration was stopped prior to surgery emotion because antiplateletnya activity. Although the exact dosage of the drug use, the drug has advantages over opioids because they do not cause nausea and vomiting.
Procedure pengeblokan peripheral nerves causing unconsciousness management in the area innervation. Analgesia can be deepened by the addition of opioids or α-adrenoceptor agonist. Unfortunately, the way pengeblokan channel peripheral nerve pain without sensory or motor blockade can not be done by a local anesthetic.
The discovery of morphine receptors on the tip of the dorsal column of spinal opioids cause neurixal (subarachnoid or epidural) to cause analgesia. Multimodal therapy in combination with opioids or local anesthetic, or a combination of both, has been used for epidural and spinal anesthesia with long postoperative analgesia. Giving neurixal opioids allow early ambulation after major surgery without pain or hemodynamic instability. Orthostatic hypotension limit ambulation when a local anesthetic continue to be given after surgery to relieve pain neurixal. When opioids are given in neurixal, distribution and opioid efficacy is determined based on the solubility of fat. A series of opioid fentanyl is very soluble in fat, and giving neurixal result in systemic absorption rate, high blood levels, and distribution of analgesia is limited. However, morphine lower solubility in fats and spreads slowly in space and epidural-subarachnoid space, giving a wider analgesia. Unfortunately, the administration of morphine neurixal resulted in increased complications, including delayed respirator depression, pruritus, and urine storage. Hydromorphone similar to morphine in producing analgesia neurixal, but has fewer side effects. Giving by patient-controlled intravenous or epidural analgesia including the use of small computerized pump delivery solutions for analgesia. The solution may contain a mixture of local anesthetics and opioids or only contain opioids. Baselinc infusion bolus doses can be performed on patients. Bolus frequency controlled to prevent inadvertent overdose. Efficacy of controlled drugs by patients are often monitored using visual-analogue scale to record the patient's perception of pain intensity that aims for fast pain relief, sustained analgesia, and minimize maintenance interventions. Giving by patient-controlled epidural is more effective than intravenous administration, which is controlled by the patient in the maintenance of analgesia after surgery, but patients feel these two methods are equally satisfactory. Nevertheless, the techniques of administration by the patient-controlled analgesia showed no reduction in inpatient days in hospital.
α-Adrenoceptor agonist (such as clonidic and medetomidine) receptors bind to prejunctional and postjunctional and work synergistically with the opioid agonist to stop the afferent nerve and brain nuclei in the nerve pain. Clonidine has been shown to cause matirasa, potentially in the inhalation anesthetics, opioids reproduce, produce anxiolysis and sedation, and control hypertension. Provision of epidural clonidine berotensi have the effect of fentanyl, reduces total opioid requirements, and reduce respiratory depression. However, besides the use of transdermal to control hypertension, clonidine is not permitted for use in the United States. Dexmedetomidine, α-Adrenoceptor agonists are very specific, reducing the total amount of isoflurane required for anesthesia during abdominal hysterectomy. The addition of this drug to liquid local anesthetic for epidural or spinal anesthesia significantly akanmemperpanjang matirasa postoperatively.
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