Novel Nonopioid Analgesics for Postoperative Pain
Abstract
Pain in the immediate postoperative period is prevalent, can be moderate to severe, and is often inadequately treated. Left untreated, acute postoperative pain can persist and even transition into chronic pain. Heightened scrutiny on the use of opioid analgesics has resulted in limitations in their use, but this should not mean that acute postoperative pain goes untreated. A variety of novel analgesic products have come to market which may be serviceable for many acute pain syndromes. These include transient receptor potential (TRP)-1 antagonists, several types of sodium channel blockers, and a “next-generating opioid” with a dual mechanism of action: cebranopadol. Other drugs in development include a next-generation cyclooxygenase inhibitor (AAT-06) and an experimental drug chemically similar to paracetamol (NTM-006). Nanomedicine can be applied to existing analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) to enhance analgesic efficacy. Older drugs, such as ketorolac, can be repurposed for easier and more efficient delivery during the postoperative period (NTM-001). Sublingual ketamine has been utilized in the postoperative setting despite a lack of consensus guidelines on dosing or indications. While ketamine is an older drug, the sublingual formulation is novel and has been used for both analgesia and psychological conditions, such as depression. These agents represent innovative developments and exploration of new pain pathways and delivery mechanisms.…
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