Table 1.

Nonopioid medications and techniques

Agent class (mechanism)	Recommended dosing (phase-of-care of administration)	Limitation(s),²¹ particularly as associated with cardiac surgery
acetaminophen (unknown; COX inhibitor?)	650-1000 mg PO every 6-8 h scheduled; max 3 g/24 h (pre-, intra-, or postoperative)	Liver toxicity
NSAIDS (nonspecific COX inhibitor)	Ketorolac [IV]: 15-30 mg every 6-8 h scheduled (postoperative) Ibuprofen [PO]: 400-800 mg every 6-8 h scheduled (postoperative)	Platelet dysfunction; gastrointestinal irritation; renal dysfunction; “black-box warning” in the setting of CABG¹⁸
dexmedetomidine (alpha-2 agonist)	0.5-1.5 μg/kg/h infusion (intra-, postoperative)	Hypotension, bradycardia
Gabapentinoids (voltage gated calcium channel modulator)	Gabapentin: 300-600 mg (pre); 100-300 mg every 8 h scheduled (postoperative) Pregabalin: 50-150 mg (preoperative); 50-150 mg every 8 h scheduled (postoperative)	Gabapentin: dizziness, sedation, respiratory depression, renally excreted, questionable efficacy¹⁹ Pregabalin: altered vision, renally excreted
lidocaine [IV] (voltage-gated sodium channel inhibitor)	1 mg/kg bolus (intra); 0.5-2.0 mg/kg/h infusion (intra-, postoperative)	Optimal dosage regimen uncertain, local anesthetic toxicity monitoring, risk for seizure
ketamine (N-methyl-D-aspartate antagonist)	0.1-1.0 mg/kg bolus (intra-); 0.1-0.2 mg/kg/h infusion (intra-, postoperative)	Tachycardia (bolus), questionable efficacy, optimal dosage regimen uncertain²⁰
regional analgesia	“Sngle shot”: serratus anterior [thoracotomy], transverse thoracic plane, parasternal, pectoralis nerve block [sternotomy] (intraoperative) catheter-based: erector spinae (pre-, intra-, postoperative)	Failure of technique, local anesthetic toxicity, unclear efficacy, wide variation in block type as well as local type and infusate adjuncts,¹⁶ special provider training necessary

COX, Cyclooxygenase; PO, per os; NSAIDs, nonsteroidal anti-inflammatory agents; IV, intravenous; CABG, coronary artery bypass grafting.