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Medication | Preop dosing regimen | Benefits | Complications |
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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 |
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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 |
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Glucocorticoids | IV dexamethasone 16 mg | Acute reduction of pain, improved hemodynamic stability, and decreased inflammatory response | Higher rate of wound infection |
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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 |
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Local anesthetics | IV lidocaine | Reduction of pain and opioid usage postoperatively | CNS and CV adverse effects |
2 mg/kg/hr |
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Metamizole | IV 1 g Metamizole | Anti-spasmodic, analgesic, and anti-inflammatory properties | Dyscrasias, kidney toxicity, cardiovascular toxicity, gastrointestinal toxicity, and anaphylaxis |
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