paracetamol + ketorolac + dexamethasone + fentanyl

This multimodal analgesia regimen is a perioperative pain management protocol developed and utilized by the National Cancer Institute, Egypt, specifically for patients undergoing breast cancer surgeries with axillary dissection to prevent post-mastectomy pain syndrome. The regimen consists of a combination of non-opioid and opioid analgesics along with an anti-inflammatory steroid. It includes intravenous paracetamol (an antipyretic and analgesic), ketorolac (a nonsteroidal anti-inflammatory drug), dexamethasone (a corticosteroid used for its anti-emetic and analgesic-potentiating effects), and intra-operative fentanyl (a potent synthetic opioid). This approach aims to provide superior pain control and reduce the incidence of chronic neuropathic pain by targeting multiple pain pathways simultaneously, including prostaglandin synthesis, glucocorticoid signaling, and opioid receptors.

Other names

Multimodal Analgesia-National Cancer Institute, Egypt-post-mastectomy pain syndromeMultimodal Analgesia (NCI Egypt protocol)