A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain Relief

Møiniche, S.; Kehlet, Henrik; Dahl, Jørgen B.

doi:10.1097/00000542-200203000-00032

Cited by 726 publications

(432 citation statements)

References 102 publications

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“…However, there is no current evidence supporting any advantage for preemptive analgesia with opioids after two detailed reviews across a broad range of surgical procedures [23,24]. Our findings of a lack of preemptive analgesia with oral opioid for UAE support the findings of these reviews.…”

Section: Discussionsupporting

confidence: 65%

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A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

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Purpose To evaluate the analgesic efficacy of oral premedication of oxycodone in a group of patients undergoing elective uterine artery embolization under sedation for fibroid disease. Methods Thirty-nine patients (mean age 42.3 years) were prospectively randomized 1:1 to receive 20 mg oxycodone or placebo orally immediately before their procedure. At the commencement of the procedure, patients were provided with a patient-controlled analgesia device for 24 h, programmed to deliver 1 mg boluses of intravenous morphine with a 5 min lockout. Mean visual analog scale pain intensity ratings (0-100 mm) were measured from both groups and evaluated over 0 to 6 h as the primary end point. Other measured parameters included opioid-related side effects and eligibility for discharge (NCT00163930; September 12, 2005). Results Early pain intensity did not vary significantly between the active and placebo groups [mean (standard deviation): 3.2 (2.5) vs. 3.1 (2.2), p = 0.89]. The oxycodone group, however, experienced significantly more nausea (p = 0.035) and a greater incidence of vomiting (p = 0.044). Overall opioid requirement over 24 h, measured as oral morphine equivalent, was greater in the oxycodone group (median [interquartile range]: 64.5

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Section: Discussionsupporting

confidence: 65%

“…Preemptive analgesia has been hypothesized as providing an advantage because pain pathways are inhibited before the onset of a painful stimulus [23]. However, there is no current evidence supporting any advantage for preemptive analgesia with opioids after two detailed reviews across a broad range of surgical procedures [23,24].…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Konstantatos

Kavnoudias

Stegeman

et al. 2014

Cardiovasc Intervent Radiol

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“…4,[8][9][10] This treatment concept is based on the idea that chronic persistent pain states, including primary and secondary hyperalgesia, allodynia, inflammatory pain, neuropathic pain, and functional somatic syndromes, are all triggered by some combination of peripheral or A central sensitization of neurons in the pain pathway. 4,[8][9][10] Preemptive analgesia is defined as any antinociceptive pain treatment that prevents the establishment of this altered central processing of painful input from sites of injury. 4,[8][9][10] The best example of preemptive analgesia is in its use for postoperative pain, in which the onset of pain can be predicted, and for which animal models have established the validity of this concept.…”

Section: How Does Chronic Pain Evolve?mentioning

confidence: 99%

“…4,[8][9][10] Preemptive analgesia is defined as any antinociceptive pain treatment that prevents the establishment of this altered central processing of painful input from sites of injury. 4,[8][9][10] The best example of preemptive analgesia is in its use for postoperative pain, in which the onset of pain can be predicted, and for which animal models have established the validity of this concept. 4 However, in clinical trials of postoperative pain, the effects of preemptive analgesia have been inconsistent, perhaps because the analgesia tested did not always fully precede, adequately block, or completely outlast the painful stimuli that accompany tissue injury from surgery.…”

Section: How Does Chronic Pain Evolve?mentioning

confidence: 99%

“…4 However, in clinical trials of postoperative pain, the effects of preemptive analgesia have been inconsistent, perhaps because the analgesia tested did not always fully precede, adequately block, or completely outlast the painful stimuli that accompany tissue injury from surgery. [8][9][10] Also, single drugs may not be as effective as multimodal pain therapies. 4 Thus, future testing of preemptive analgesia may combine anti-inflammatory agents, to block pain transduction peripherally, with regional anesthesia, to block pain transmission centrally, using central analgesics such as opiates, dual serotonin and norepinephrine reuptake blockers, and voltage sensitive calcium channel (VSCC) modulators of α 2 δ sites.…”

Section: How Does Chronic Pain Evolve?mentioning

confidence: 99%

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Preemptive Analgesia: Is Pain Less Costly When You Pre-Pay For It?

Stahl¹

2004

J. Clin. Psychiatry

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Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

Dort

Farwell

Findlay

et al. 2017

JAMA Otolaryngol Head Neck Surg

380

257

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Importance: Head and neck cancers often require complex, labor-intensive surgeries, especially when free flap reconstruction is required. Enhanced recovery is important in this patient population but evidence-based protocols on perioperative care for this population are lacking. Objective: To provide a consensus-based protocol for optimal perioperative care of patients undergoing head and neck cancer surgery with free flap reconstruction. Evidence Review: Following endorsement by the Enhanced Recovery After Surgery (ERAS) Society to develop this protocol, a systematic review was conducted for each topic. The PubMed and Cochrane databases were initially searched to identify relevant publications on head and neck cancer surgery from 1965 through April 2015. Consistent key words for each topic included "head and neck surgery," "pharyngectomy," "laryngectomy," "laryngopharyngectomy," "neck dissection," "parotid lymphadenectomy," "thyroidectomy," "oral cavity resection," "glossectomy," and "head and neck." The final selection of literature included meta-analyses and systematic reviews as well as randomized controlled trials where available. In the absence of high-level data, case series and nonrandomized studies in head and neck cancer surgery patients or randomized controlled trials and systematic reviews in non-head and neck cancer surgery patients, were considered. An international panel of experts in major head and neck cancer surgery and enhanced recovery after surgery reviewed and assessed the literature for quality and developed recommendations for each topic based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations were graded following a consensus discussion among the expert panel. Findings: The literature search, including a hand search of reference lists, identified 215 relevant publications that were considered to be the best evidence for the topic areas. A total of 17 topic areas were identified for inclusion in the protocol for the perioperative care of patients undergoing major head and neck cancer surgery with free flap reconstruction. Best practice includes several elements of perioperative care. Among these elements are the provision of preoperative carbohydrate treatment, pharmacologic thromboprophylaxis, perioperative antibiotics in clean-contaminated procedures, corticosteroid and antiemetic medications, short acting anxiolytics, goal-directed fluid management, opioid-sparing multimodal analgesia, frequent flap monitoring, early mobilization, and the avoidance of preoperative fasting. Conclusions and Relevance: The evidence base for specific perioperative care elements in head and neck cancer surgery is variable and in many cases information from different surgerical procedures form the basis for these recommendations. Clinical evaluation of these recommendations is a logical next step and further research in this patient population is warranted.

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A Qualitative and Quantitative Systematic Review of Preemptive Analgesia for Postoperative Pain Relief

Cited by 726 publications

References 102 publications

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

A Randomized, Double-Blind, Placebo-Controlled Study of Preemptive Oral Oxycodone with Morphine Patient-Controlled Anesthesia for Postoperative Pain Management in Patients Undergoing Uterine Artery Embolization for Symptomatic Uterine Fibroids

Preemptive Analgesia: Is Pain Less Costly When You Pre-Pay For It?

Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction

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