Table 1.

Commonly used non-opioid analgesics

Medication	Mechanism of Action	Recommended dose	Advantages	Disadvantages
Acetaminophen	Central COX inhibition	>50 kg: 1000 mg q6h <50 kg: 15 mg/kg q6h	Lack of respiratory, renal, cardiovascular, and bleeding effects	Hepatotoxicity at doses > 4g; Hypotension if given intravenously
Non-steroidal anti-inflammatory drugs	COX inhibition	Ketorolac: 15-30 mg q6h Celecoxib: 50-200 mg single dose.	No effect on respiratory drive	Inhibit platelet aggregation; Gastrointestinal ulcers and renal dysfunction
Ketamine	NMDA inhibition	IV bolus : 0.5 mg/kg Infusion: 0.1-0.2 mg/kg/hour	Minimal effect on respiratory drive	Sympathomimetic and psychotropic effects, increase salivation, potentially increase IOP and ICP
Gabapentinoids	Inhibition of voltage-gated calcium channel	600-1200 mg TID		Confusion and excessive sedation; potentiate respiratory depression of opioids; dose reduction required in patients with renal dysfunction
Dexmedetomidine	Central alpha-2 adrenergic agonist	IV bolus: 0.5-1 mg/kg bolus over 10 min Infusion: 0.2-1 mcg/kg/hour	Minimal effect on respiratory drive	Bradycardia and hypotension
Lidocaine	Voltage-gated sodium channel blocked and anti-inflammatory effect	IV bolus; 1.5 mg/kg Infusion: 1-2 mg/kg/hour IV	Minimal effect on respiratory drive	Local anesthetic systemic toxicity
Magnesium	NMDA inhibition	IV bolus: 30-50 mg/kg Infusion: 8-15 mg/kg/hour	Minimal effect on respiratory drive	Potentiates neuromuscular blockade; Contraindicated in renal failure
Esmolol	Central neuronal modulation and anti-inflammatory	IV bolus: 0.5 mg/kg Infusion: 5-15 μg/kg/min	Minimal effect on respiratory drive	Bradycardia and hypotension

COX: cyclooxygenase. NMDA: N-methyl-D-aspartate. TID: Three times a day.