Evidence-Based Use of Nonopioid Analgesics

Analgesia is a necessary component of any anesthetic technique, and can be achieved with local anesthetics, opioid and nonopioid analgesics, and inhaled anesthetic agents. Risks and benefits are associated with each of the agents and techniques described here, including local anesthetic systemic toxicity, respiratory depression, nausea, and urinary retention. Implementation of Enhanced Recovery After Surgery (ERAS) protocols, use of preemptive analgesia techniques, and the national opioid crisis are fostering increased utilization of nonopioid analgesics, including local anesthetics, nonsteroidal anti-inflammatory medications, intravenous acetaminophen, neuromodulatory agents such as gabapentin, corticosteroids, centrally acting a2 agonists, and ketamine. Certified Registered Nurse Anesthetists optimize the safety and quality of care they provide through use of evidence-based practice, including the drugs they select, order, and administer, such as opioid and nonopioid analgesics, when providing anesthesia care.