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 I.  Introduction

A.  Opioid analgesics are widely used drugs for the management of both acute and chronic pain. Side effects of opioids may limit their use and concerns over drug dependence; misuse and abuse sets boundaries on their use.

B.  Nonopioid centrally administered analgesics relieve pain by mechanisms unrelated to opioid receptors; they do not cause respiratory depression, physical dependence, or abuse and are not regulated under the Controlled Substances Act.

C.  In order to minimize the adverse effects of opioid analgesic medications, anesthesiologists and surgeons are increasingly turning to nonopioid analgesic techniques (multimodal analgesia) as adjuvants for managing pain during the perioperative period.

D.  Neuraxial drug administration is a group of techniques that deliver drugs in close proximity to the spinal cord (intrathecally into the cerebrospinal fluid [CSF] or epidurally into the fatty tissues surrounding the dura) by injection or infusion (bypasses the blood–brain barrier, resulting in much higher CSF concentrations while using reduced amounts of medication to achieve equipotent doses).

II.  α₂-Adrenergic Agonists. Epidural or intrathecal administration of α₂-adrenergic agonists provides analgesia by activating α₂

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