Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1

In this 108th episode I welcome Dr. Mike Grant and Dr. Mark Bicket to the show to discuss various non-opioid adjuncts such as esmolol, ketamine, dexmedetomidine, lidocaine, and magnesium, and the role they may play in multimodal anesthesia. In this episode, part 1, we discuss pre and post-op use. Intraop use will be discussed in episode 109.

References:

Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697.

Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care. Regional Anesthesia and Pain Medicine. 2018:43(8):815-818.

Grant MC, Ouanes JP, Joshi BL. Perioperative Esmolol and Opioids: Is More Really Less? Regional Anesthesia and Pain Medicine. 2018:43(8):813-814.

IV Lidocaine: https://academic.oup.com/bjaed/article/16/9/292/1743710

Ketamine: https://www.ncbi.nlm.nih.gov/pubmed/29870457

Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866/ R

10 Replies to “Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1”

  1. Hi Jett,

    I work in Melbourne, Australia, and we frequently use clonidine as an adjunct if the BP can tolerate.

    Would love to hear some discussions on the evidence out there.

    Cheers,
    Jonathan

  2. Thank you for a great episode! What if the patient is already on Gabapentin at home at less than 600mg- continue scheduled dosing or give PO bolus (600mg) in pre-op? Appreciate recommendations.

    1. Hi Anastasia,

      You would want to know if they had had a bad reaction to a higher dose. If not, giving them the usual 600 should be fine, or, if they took their home 300 (for example) that morning, giving them an additional 300 in preop.

  3. Hi Jed,

    I’ve got a lot of interest in the use of Mg as a possible adjunct in MAC anesthetics to possibly reduce opioid use. I’m having some difficulty finding exactly what was referenced in this episode. Would you or your guests happen to have any references you could share? Thanks so much!

    1. Dr Grant recommends this meta analysis with tons of great references De Oliveira GS, Jr., Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013;119(1):178-190.

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