1. Multimodal analgesia A brief summary
Daniel Nash CRNA DNAP

2. 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.

3. 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

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

5. 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

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

12. NDMA antagonists
Ketamine
Magnesium

13. Neuroplasticity

17. Magnesium infusion

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