Non-opioid analgesic options

Abstract

The provision of safe and effective perioperative analgesia forms one of the cornerstones of anaesthetic practice. Traditionally this has been achieved with a mix of paracetamol, non-steroidal anti-inflammatory drugs and opioids. Opioids have formed the backbone of our analgesic strategy for a number of years and can provide excellent analgesia. However the side-effect profile of these drugs can prove unsatisfactory. It is also important to be cognizant of the potential for abuse and addiction associated with even the short-term use of opioid analgesics. A cohort study in the British Medical Journal demonstrated that almost 50% of patients were discharged home with opioid prescriptions after elective surgery and that 3% of them were still taking opioids 90 days after surgery.¹ Rates of opioid use and addiction are not known in South Africa but with thousands of patients undergoing surgery annually it cannot be assumed that we are immune to the problems of opioid abuse. As such the use of non-opioid and non-traditional analgesics is gaining traction.