Antidepressants in Perioperative Pain Management

OpioidsOpioids are the cornerstone therapy in perioperative pain managementPerioperative pain management. Although opioidsOpioids are strong analgesicsAnalgesics, they are less effective in controlling neuropathic painNeuropathic pain and are associated with multiple adverse effectsAdverse effect such as delirium, sedation, respiratory depressionDepression, postoperative nausea and vomiting (PONV), constipation, and opioidOpioids induced hyperalgesia. Furthermore, opioidsOpioids prescribed for post-operative painPain control are associated with an increased riskRisks of opioid use disorderOpioid use disorder (OUD). In order to limit opioidOpioids use and associated adverse effectsAdverse effect, and optimize pain managementPain management, non-opioid analgesicsAnalgesics have been studied as adjunctive therapies in perioperative pain managementPerioperative pain management. The role of antidepressantsAntidepressants is well established in chronic painChronic pain managementPain management. Recent studies have evaluated the efficacy of antidepressantsAntidepressants in acute painAcute pain settings. This chapter will review antidepressantsAntidepressants as adjunctive therapies in perioperativePerioperative scenarios. We will discuss the pharmacology of tricyclic antidepressantsTricyclic antidepressants (TCA) (TCA), serotonin norepinephrine receptor inhibitorsSerotonin norepinephrine receptor inhibitors (SNRI) (SNRI), and serotonin selective reuptake inhibitors (SSRI) and then review salient studies on the use of antidepressantsAntidepressants in a variety of surgical settings.