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ketamine + fentanyl + lidocaine + magnesium + clonidine + remifentanil
- Development stage
- Unknown
- Lead developer
- University Hospital Basel
- Modality
- Small Molecules, Device-based Delivery → Drug Delivery Systems
- Administration
- Intravenous
01
Overview
This multi-modal opioid-sparing anesthesia protocol was developed by the University Hospital, Basel, for the management of surgical pain, particularly in patients undergoing laparoscopic surgery. The regimen combines low-dose mu-opioid receptor agonists (fentanyl and remifentanil) with several non-opioid adjuncts to achieve synergistic antinociception while minimizing opioid-related adverse effects. These adjuncts include ketamine (an NMDA receptor antagonist), lidocaine (a sodium channel blocker), magnesium (an NMDA antagonist and calcium channel blocker), and clonidine (an alpha-2 adrenergic receptor agonist). The protocol is typically administered intravenously alongside baseline hypnotics and muscle relaxants. Its clinical efficacy is often evaluated using the PMD-200 device, which monitors the Nociception Level (NOL) index to provide a physiological measure of the balance between nociceptive stimuli and analgesic coverage.
- Other names
- opioid-sparing anesthesia protocol
02
Targets
NMDAR (Glutamate receptor ionotropic, NMDA)ADRA2A (α2A)ADRA2B (α2B)MOR (Mu opioid receptor)NaV (Voltage-gated sodium channels)CaV (Voltage-gated calcium channel protein complex)
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