Rozario presents the surgical dilemma of use and abuse of opioids in pain management in surgical patients.1 Besides the integrated systems approach detailed by Rozario, I offer my experience with metoclopramide (MTCL) as a useful non-opiate agent for managing acute severe pain, surgical or nonsurgical.2–4 While consensus statements and guidelines have proven insufficient to overcome opioid abuse, the definitive pharmacologic basis of the analgesic action of MTCL is a welcome addition, but one that is largely ignored. I have used MTCL 20 mg as slow IV bolus (over 2 minutes) and up to 60 mg in GNS 500 mL drip for severe headache, refractory migraine, and nonspecific abdominal pain as an early management strategy with good results (unpublished observations). Care should be exercised in administering MTCL. I always administer MTCL bolus myself rather asking nurses/nursing attendees to do so. Mild sedation, diarrhea and reversible extrapyramidal reactions can occur without long-term or cumulative adverse effects.
Besides its routine antiemetic effect, MTCL releases vasopressin, which in conjunction with serotonin and noradrenaline, forms a powerful adaptive nexus with brain neuronal antinociceptive, vasomotor, and behavioural functions,5–7 all of which are useful in the postoperative state.
References
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