Multimodal analgesia A brief summary

1. Multimodal analgesia A brief summary Daniel Nash CRNA DNAP

2. Objectives • Name basic goals of multimodal therapies • Discuss target sites of multimodal therapies • Pharmacologic and non-pharmacologic • Discuss medications for multimodal therapy and learn their site of action.

3. Goals of multimodal analgesia • Block nociceptive transmission along multiple targets along the pain pathway. • Preventative in nature – stop before it starts • Augment bodies natural pain inhibition pathways • Reduce stress response • Reduce opioid complications

4. Non-pharmacological therapy • Ice and elevation • Hypnosis, imagery, acupuncture • Music therapy – headphones in surgery • TENS units • Cognitive behavioral therapy

5. Multimodal targets • Mediators of pain/inflammation • Thromboxane and prostaglandins • Voltage gated Na+ channels- peripheral nerve blocks • Neurotransmitter sites • Opioid receptors • NDMA receptors • Alpha 2 receptors • Presynaptic voltage gated Ca++ channels • Cannabinoid receptors • Vanniloids (TRPV-1) Capsaicin • Seritonergic and antidepressants

7. NSAIDS • COX 1 & 2 • Aspirin • Acetominophen- Ofirmev • Toradol, Indocin, Ibuprofen, Naprosyn • Cox 2 • Celebrex (Vioxx and Bextra off market)

12. NDMA antagonists Ketamine Magnesium

13. Neuroplasticity

17. Magnesium infusion

19. Fraudulent initial research but accurate results! Multimodal has since been verified as effective through many well designed outcome based research studies.