Opioid Sparing Analgesics in Spine Surgery

Table 1

Proposed preoperative non-opioid medications and dosing regimens.

Medication	Preop dosing regimen	Benefits	Complications
Gabapentinoids	600 mg within two hours prior to surgery	Reduction of pain scores, reduction of total morphine equivalents, and longer time to first analgesics	Increased risks of sedation, respiratory depression and potentiation of the respiratory depressant effects of opioids
Acetaminophen	650 mg IV every four hours or 1000 mg every six hours IV	Increased analgesic control, decreased opioid use, and more cost-effective care	Some contraindications including severe liver disease, and some drug interactions
Glucocorticoids	IV dexamethasone 16 mg	Acute reduction of pain, improved hemodynamic stability, and decreased inflammatory response	Higher rate of wound infection
NMDA agonist	IV ketamine	Reduction of pain scores, reduction of total morphine equivalents, and longer time to first analgesics	Altered mental status
	0.15–0.5 mg/kg
Alpha-2-agonists (dex and Clonidine)	Dex IV infusion 0.2 µg/kg/hr	Decreased pain scores,	Bradycardia, hypotension, sedation
	Oral clonidine 0.2 mg	Decreased MME	Dry mouth, sedation
		Decreased EBL
Local anesthetics	IV lidocaine	Reduction of pain and opioid usage postoperatively	CNS and CV adverse effects
	2 mg/kg/hr
Metamizole	IV 1 g Metamizole	Anti-spasmodic, analgesic, and anti-inflammatory properties	Dyscrasias, kidney toxicity, cardiovascular toxicity, gastrointestinal toxicity, and anaphylaxis