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Pain is the most common symptom in patients referred to the emergency department (ED), so its rapid and effective relief can increase patients’ satisfaction as well as decrease their physical and mental complications.1 Morphine is the most commonly used opioid in emergency medicine (EM) to relieve pain in patients. Despite its accessibility and its ability to alleviate pain, it has side effects such as excessive sedation and increased respiratory depression, and also its effectiveness in cases of severe pain is controversial. Therefore, the use of other non-opioid analgesic drugs can be helpful in controlling the pain of patients referred to the ED in cases where we have limited opioid use.1-3 In the following, we mention some of these drugs. Lidocaine as an amino amide local anesthetic agent inhibits voltage-dependent sodium channels and impulses in axon.2-4 Lidocaine causes alteration in sympathetic smooth muscle tone by decreasing the transmission of afferent sensory pathways. Intravenous (IV) administration of lidocaine causes significant decrease in pain and can be a proper substitute for cases in which narcotics are unsuccessful or associated with adverse effects.3 Lidocaine has been successfully used to relieve pain in patients with renal colic compared to morphine. The quickness and reduction of pain relief by lidocaine is significantly greater than that of morphine.3 Another drug is magnesium sulfate which is used in patients with trigeminal neuralgia. Magnesium (Mg2+) and the N-methyl-D-aspartate (NMDA) receptors are involved in the pain management. Magnesium has been recommended as a treatment choice for migraines due to its NMDA receptors blockage property. The NMDA receptors play the most important role in the progress of hypersensitivity states and the mechanisms responsible for central sensitization in the spinal cord. They are significantly important in the setting up process of different chronic neuropathic pain situations. Magnesium sulfate (MgSO4) is an NMDA receptor antagonist and inhibitor of voltage gated calcium channel. Intravenous administration of MgSO4 (1 g) has also been Editorial

Opioid-free analgesia in the emergency department: A new aspect