With increasing frequency, we encounter patients to whom, under the banners of enhanced recovery after surgery and multimodal analgesia, a multitude of drugs have been administered. At times, the melange can include a cyclooxygenase-2 inhibitor, dexamethasone, dexmedetomidine, fentanyl (and/or other opioids), gabapentin, ketamine, lidocaine, midazolam, magnesium, scopolamine (transdermal), and a volatile anesthetic. The recent articles by Beloeil et al., Shanthanna et al., and Kharasch and Clark have all presented timely and clinically pertinent discussions of the analgesic limitations of the multimodal analgesia regimens that have been implemented in the name of opiate sparing and opioid-free anesthesia.1–3  However, we suspect that the hazards of these regimens have not been given sufficient emphasis. While the enhanced recovery after surgery and multimodal analgesia banners may be worthy ones, and their benefits may be substantial, the potential harms have...

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