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Pharmacology - Analgesic Agents

Below is a summary of commonly used anaglesic agents. Note that some agents are often used for multiple indications. Doses are IV, unless indicated. Also note that less common agents are detailed in the AFMS manual.

The agents are listed with the generic name followed by the trade name in brackets.

Fentanyl

  • Mechanism
    • Opioid receptor agonism
  • Indication
    • Analgesia
  • Dosing
    • 0.5-1 mcg/kg or 25-50 mcg
    • 2-3mcg/kg for co-induction.
  • Considerations
    • Effect termination within the hour by redistribution
    • As with any opioid, increases post-op nausea

Hydromorphone (Dilaudid)

  • Mechanism
    • Opioid receptor agonism
  • Indication
    • Analgesia
  • Dosing
    • 0.3 mcg-0.5 mcg/kg or 0.2-0.4 mg
  • Considerations
    • Divide oral dose by 4 to obtain IV dose
    • Caution in patients at risk of respiratory depression
    • Preferred over morphine in renal patients

Morphine

  • Mechanism
    • Opioid receptor agonism
  • Indication
    • Analgesia
  • Dosing
    • 0.01-0.03 mg/kg or 1-2 mg
  • Considerations
    • Divide oral dose by 2.5 to obtain IV dose
    • Caution in patients at risk of respiratory depression and those with renal disease renal clearance)

Ketorolac (Toradol)

  • Mechanism
    • COX-1 & 2 inhibition
  • Indication
    • Analgesia
  • Dosing
    • 0.5 mg/kg or 15-30 mg
  • Considerations
    • Provide at end of operation
    • Avoided in pts with greater bleeding risk (e.g. tonsillectomies), asthma, HTN, renal disease, coagulopathy, and those who have undergone orthopedic surgery

Ibuprofen (Advil, Motrin)

  • Mechanism
    • COX-1 & 2 inhibition
  • Indication
    • Analgesia
  • Dosing
    • 200-400mg PO q4-8h (Max 1600 mg/24 hrs)
  • Considerations
    • Base of multimodal analgesia
    • Avoid if asthma or COPD, CAD, hypertension, renal disease or PUD
    • COX-2 does not affect platelet function but may cause cardiac complication if used > 5d.

Celecoxib (Celebrex)

  • Mechanism
    • COX-2 inhibition
  • Indication
    • Analgesia
  • Dosing
    • 100-200mg PO q12h
  • Considerations
    • Base of multimodal analgesia
    • Avoid if asthma or COPD, CAD, hypertension, renal disease or PUD
    • COX-2 does not affect platelet function but may cause cardiac complication if used > 5d.

Acetaminophen (Tylenol)

  • Mechanism
    • Unknown
  • Indication
    • Analgesia
      • Dosing: 250-1000 mg PO
    • Antipyretic
      • Dosing: q4-8h (Max 4000mg/24 hrs)
  • Considerations
    • Base of multimodal analgesia with NSAIDS
    • Caution in liver disease

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