Tramadol (Ultram) is often prescribed for analgesia because it’s easy to write for (especially at hospital discharge); however, its pharmacology makes it unreliable for pain control. The parent compound has only weak affinity for the mu opioid receptor, so most of the meaningful opioid effect comes from its active metabolite…
Acetaminophen (Tylenol) is routinely administered in IV and PO (pill) forms in perioperative and critical care medicine, but the debate of which route of administration is superior comes up all the time, despite the evidence being consistent for years. TLDR – once both formulations are absorbed, the analgesic effect is…
Pain management remains a significant challenge in clinical medicine, especially as the opioid crisis underscores the need for safer alternatives. Voltage-gated sodium channels (NaV) play a crucial role in pain signaling, with NaV1.8 being a key contributor in peripheral sensory neurons. Suzetrigine (VX-548), recently FDA-approved as Journavx™, is a highly…
Liposomal bupivacaine (Exparel) is a local anesthetic touted for the long duration of its activity. Molecules of bupivacaine are encapsulated within multivesicular liposomes composed of endogenous lipids like cholesterol and phospholipids; these liposomes undergo rearrangement to cause a slow release of bupivacaine over 2-3 days.
Celecoxib (Celebrex) is an oral, non-steroidal anti-inflammatory drug (NSAID). This class of medications typically inhibits two major isozymes: COX-1 (responsible for platelet aggregation, kidney perfusion, and gastrointestinal mucosa protection) and COX-2 (produced as a result of tissue damage to mitigate the inflammatory response). By selectively inhibiting COX-2, celecoxib tries to…
Fentanyl (Sublimaze) is the most common synthetic narcotic I administer in the OR and the ICU. It is ~100x more potent than morphine and associated with many of the same side effects as other mu-opioid agonists – nausea, vomiting, constipation, respiratory depression, hallucinations, and sedation. Fentanyl can be delivered through…
Ketorolac (Toradol) is a nonsteroidal anti-inflammatory drug (NSAID) I use as an analgesic adjunct in the OR and ICU. In some anesthesia texts, a single dose of IV ketorolac is said to confer analgesia equivalent to 10 mg of IV morphine (without narcotic-related side effects)! There’s some evidence from the…
Ketamine (Ketalar) is my FAVORITE medication in perioperative and critical care medicine! It’s a unique dissociative amnestic, an almost complete anesthetic in itself, has tremendous versatility in terms of routes of administration (IV, IM, oral, subcutaneous, intranasal, sublingual, rectal, epidural, transdermal), and unique properties as an analgesic and antidepressant!
Intravenous (IV) acetaminophen (Ofirmev) is a prime example of how multimodal analgesia can be augmented in the perioperative and ICU settings; however, just as with all things, cost drives availability. Literature has emerged trying to show the cost-effectiveness of IV acetaminophen compared to its oral counterpart, but some of these…
