AANA December 2021 Journal Course: Alpha-2 Adrenergic Agonist, An Attractive but Underutilized ERAS Component in Improving Fast Track Recovery and Surgical Outcomes-Article

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Enhanced Recovery After Surgery (ERAS) protocols are evidence-based pathways designed to improve surgical outcomes and decrease opioid consumption, complications, length of stay, and healthcare costs. Multimodal pain management is a crucial component of these protocols, but postoperative pain management remains suboptimal in many cases. α2-Adrenergic receptor (α2-AR) agonists, such as clonidine and dexmedetomidine, are attractive options for improving fast-track recovery and surgical outcomes. These agonists have unique analgesic properties, including antinociception, anxiolysis, anti-inflammation, and renal protection. They work by inhibiting the release of neurotransmitters, modulating pain pathways, and activating descending pain modulatory pathways. Multiple studies have shown that α2-AR agonists can decrease opioid consumption and side effects in adult and pediatric surgical patients. They have also been associated with a reduction in anxiety, perioperative stress, inflammation, postoperative nausea and vomiting, shivering, and cognitive dysfunction. However, these agonists are underused in many ERAS programs. In addition to improving acute pain management, α2-AR agonists have been found to have beneficial effects on hyperalgesia, postoperative nausea and vomiting, and the management of opioid and nonopioid withdrawal symptoms. They also have potential renal protective effects and can modulate immuno-inflammatory responses. Although they have some side effects, long-term use of α2-AR agonists has been deemed safe. Overall, α2-AR agonists are promising additions to perioperative multimodal analgesia and ERAS protocols.

Keywords

Enhanced Recovery After Surgery

ERAS protocols

surgical outcomes

opioid consumption

multimodal pain management

α2-Adrenergic receptor agonists

fast-track recovery

pain pathway modulation

opioid consumption reduction

renal protective effects