Current status of pre-emptive analgesia

Abstract

Purpose of reviewThe controversy over pre-emptive analgesia continues unabated, with studies both supporting and refuting its efficacy. The timing of an analgesic intervention and presence of a placebo control may have significant impact on the interpretation of results and may have led to the premature conclusion that pre-emptive analgesia is of limited clinical utility. A review of the recent literature using strict definitions of preemptive and preventive analgesia is required in order to clarify the broader issue of the benefits of perioperative analgesia. Recent findings A total of 27 studies, published from April 2001 to April 2002, were found to evaluate pre-emptive (n = 12) or preventive analgesia (n = 15). Evidence for a benefit of preventive analgesia was strong, with 60% of studies finding reduced pain or analgesic consumption beyond the clinical duration of action of the analgesic intervention. Evidence for a benefit of preemptive analgesia was equivocal, with 41.7% of studies demonstrating that preincisional treatment reduces pain or analgesic consumption to a greater extent than does postincisional treatment. Summary Studies that used a preventive design had a greater likelihood of finding a beneficial effect. The application of preventive perioperative analgesia (not necessarily preincisional) is associated with a significant reduction in pain beyond the clinical duration of action of the analgesic agent, in particular for the N-methyi-D-aspartate antagonists. The classical definition of pre-emptive analgesia should be abandoned in favor of preventive analgesia. This will broaden the scope of inquiry from a narrow focus on preincisional versus postincisional interventions to one that aims to minimize postoperative pain and analgesic requirements by reducing peripheral and central sensitization arising from noxious preoperative, intraoperative and postoperative inputs.

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

“…The call for the implementation of clinical programs and research into risk factors associated with the transition of acute to chronic post-surgical pain has been longstanding [86][87][88]. However, equally problematic but less often discussed is the issue of prolonged opioid use associated with CPSP.…”

The Effect of a Preoperative Single Dose of Magnesium Sulfate versus Preoperative Ultrasound Guided Bilateral Transversus Abdominis Plane Block on Hemodynamics and Postoperative Analgesic Requirements in Patients Undergoing Colorectal Surgery

“…Preventive analgesia is appropriate term which utilize preemptive analgesia and multimodal techniques, began before operation and continued in the operative and postoperative time, it combines multiple analgesics regimen which reduce the dose of each drugs, reduce or eliminate the unwanted side effects, enhance recovery and reduce the hospital stay and associated with early discharge from hospital, increased duration of action of analgesic drugs to decrease long-term pain sensitivity at the peripheral and central levels [21][22][23].…”

The Evaluation of Safety and Analgesic Efficacy of Paracetamol and Ibuprofen Followed by Impacted Third Molar Surgery

“…There are conflicting results concerning preemptive and preventive administration of different groups of analgesics. Preventive analgesia was considered to be a suitable definition of both the preoperative and intraoperative administration of drugs for preventing the pain before its onset after surgical procedures (15)(16)(17). Based on this knowledges, the analgesic drugs were administered 30 minutes before the surgery.…”