Psychiatric agents and implications for perioperative analgesia

• Published in: Best practice & research. Clinical anaesthesiology Vol. 28; no. 2; pp. 167 - 181
• Main Authors: Catalani, Blas, MD, MPH, Hamilton, Craig S., MD, Herron, Edwin W., MD, Urman, Richard D., MD, MBA, Fox, Charles J., MD, Kaye, Alan David, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2014
• Subjects: adult; Analgesia - methods; analgesic agents; analgesic drugs; analgesics; Anesthesia & Perioperative Care; anorexic drugs; anorexigenic drugs; anticonvulsants; antidepressive agents; antidepressive agents, tricyclic; antipsychotic drugs; anxiolytics; barbiturates; benzodiazepines; buspirone; central stimulants; Humans; lithium carbonate; monoamine oxidase inhibitors; neuroleptanalgesia; neuroleptic drugs; neurotransmitter uptake inhibitors; pain; perioperative care; Perioperative Care - methods; perioperative period; Psychotropic Drugs; serotonin uptake inhibitors; antidepressive agents; barbiturates; antidepressive agents, tricyclic; monoamine oxidase inhibitors; buspirone; analgesics; serotonin uptake inhibitors; anorexigenic drugs; antipsychotic drugs; neuroleptic drugs; lithium carbonate; perioperative care; pain; benzodiazepines; anxiolytics; anorexic drugs; analgesic agents; perioperative period; psychotropic drugs; neurotransmitter uptake inhibitors; central stimulants; analgesic drugs; adult; anticonvulsants; neuroleptanalgesia
• ISSN: 1521-6896; 1532-169X; 1878-1608
• DOI: 10.1016/j.bpa.2014.05.001

The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose–response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.