Multimodal analgesia A brief summary Daniel Nash CRNA DNAP

Objectives Name basic goals of multimodal therapies Discuss target sites of multimodal therapies Pharmacologic and non-pharmacologic Discuss medications for multimodal therapy and learn their site of action.

Goals of multimodal analgesia Block nociceptive transmission along multiple targets along the pain pathway. Preventative in nature – stop before it starts Augment bodies natural pain inhibition pathways Reduce stress response Reduce opioid complications

Non-pharmacological therapy Ice and elevation Hypnosis, imagery, acupuncture Music therapy – headphones in surgery TENS units Cognitive behavioral therapy

Multimodal targets Mediators of pain/inflammation Thromboxane and prostaglandins Voltage gated Na+ channels- peripheral nerve blocks Neurotransmitter sites Opioid receptors NDMA receptors Alpha 2 receptors Presynaptic voltage gated Ca++ channels Cannabinoid receptors Vanniloids (TRPV-1) Capsaicin Seritonergic and antidepressants

NSAIDS COX 1 & 2 Cox 2 Aspirin Acetominophen- Ofirmev Toradol, Indocin, Ibuprofen, Naprosyn Cox 2 Celebrex (Vioxx and Bextra off market)

NDMA antagonists Ketamine Magnesium

Neuroplasticity

Magnesium infusion

Fraudulent initial research but accurate results! Multimodal has since been verified as effective through many well designed outcome based research studies.