Non-opioid Adjuncts and Alternatives

Periprocedural use of opioid-containing agents by medical providers is a practice that continues to shape the US opioid crisis. Consensus guidelines recommend reduction of opioid use whenever possible. Numerous alternative non-opioid analgesic agents exist to replace the sole use of opioids with multimodal analgesia. Data supports the use of adjuvant non-opioid analgesic agents that offer opioid-sparing action and reduce the occurrence of postoperative side effects. Commonly used analgesics include nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentinoids, N-methyl-D-aspartate antagonists, and alpha-2 adrenergic agonists. Procedure type, facility setting, and patient-specific factors dictate which non-opioid alternative and adjunct agents are appropriate. Incorporation of these agents is likely to increase over time due to improved patient recovery times, reduced reliance on opioids, and minimized procedural costs.