Uso de coadyuvantes en dolor postoperatorio / Use of adjuvants in postoperative pain

Resumen: Los analgésicos coadyuvantes son compuestos que tienen una baja potencia analgésica. Sin embargo, la sinergia con opioides incrementa su efecto y favorece una reducción en los eventos adversos de los narcóticos para el control del dolor postoperatorio. Las estrategias ahorradoras de opioides están relacionadas con el efecto de una variedad de receptores, de los cuales podemos nombrar: los antagonistas NMDA como la ketamina, magnesio y dextrometorfano, los agonistas α-2 como la clonidina y la dexmedetomidina, los inhibidores de la subunidad α-2δ de los canales de calcio como la pregabalina y la gabapentina, los bloqueadores de los canales de sodio como la lidocaína y, finalmente, los glucocorticoides. En esta revisión se describirán las características, indicaciones, dosis y niveles de evidencia del uso de los coadyuvantes de uso intravenoso y regional en el contexto perioperatorio. (visite http://www.painoutmexico.com para ver artículo completo y Tablas).

Abstract: The adjuvant analgesics are compounds that have a low analgesic potency. However, with these compounds, the adverse effects of opioids may be diminished for the control of postoperative pain. Opioid-sparing strategies are related to the effect on a variety of receptors, of which we should name: the NMDA antagonists such as ketamine, magnesium and dextromethorphan, the α-2 agonists such as clonidine and dexmedetomidine, subunit α-2δ of calcium channels inhibitors; such as pregabalin and gabapentin, sodium channels blockers such as lidocaine and finally glucocorticoids. In this review we describe the characteristics, indications, doses and levels of evidence of use of adjuvants in the perioperative context (visit http://www.painoutmexico.com to see the full article and Tables).

Consumption pattern of gabapentinoids in a tertiary health-care system: a five year study from 2012-2017

Background: Treating chronic pain has always been a great challenge for the treating physician. As the available pharmacotherapy do not always yield desired results, wider armamentarium is needed in tackling the chronic pain. Hence gabapentinoids are often considered, but it has led to widespread off label use of these groups of medications. Hence a study of consumption pattern was carried out to assess the usage of gabapentinoids.Methods: The consumption pattern of gabapentinoids (gabapentin/ pregabalin/ any combination) was recorded from the medical stores and dispensary of tertiary care teaching hospital.Results: There is an upward trend in the usage of all gabapentinoids between 2012 to 2017 and pregabalin was seen to be the commonly used gabapentinoid. In the recent years apart from individual gabapentinoids there is a trend favoring use of FDCs of gabapentinoids with nortryptyline and methylcobalamine.Conclusions: The increase in the usage pattern should alarm us to look into the off label uses of gabapentinoids. As there is a possibility of abuse and misuse of gabapentinoids clear guidelines regarding the same is the need of the hour.