Pre-emptive analgesia

Abstract

Transmission of pain signals evoked by tissue damage leads to sensitization of the peripheral and central pain pathways. Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce this sensitization. Owing to this 'protective' effect on the nociceptive system, pre-emptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery. Theoretically, immediate postoperative pain may be reduced and the development of chronic pain may be prevented. Although some clinical studies have demonstrated significant effects on acute postoperative pain, no major clinical benefits of pre-emptive analgesia have been documented. The only way to prevent sensitization of the nociceptive system might be to block completely any pain signal originating from the surgical wound from the time of incision until final wound healing. Other pharmacological interventions, including 'antihyperalgesic' drugs such as NMDA-receptor antagonists and gabapentin, may interfere with the induction and maintenance of sensitization. Future studies will investigate the analgesic effect of prolonged multimodal combinations of different classes of 'traditional' analgesics and 'antihyperalgesics' on postoperative pain.

Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis

“…Preemptive analgesia is a treatment initiated before the surgical procedure in order to reduce this sensitization 21 . In the present meta-analysis, we assessed the efficacy and safety of ketamine.…”

The Effectiveness of Preemptive Analgesic Techniques on Postoperative Analgesia In Patients Undergoing Open Septorhinoplasty

“…[6] Preemptif tedavi uygulanan 80 çalışmanın sonuçlarının incelendiği bir meta-analizde, NSAİİ ilaçların, intravenöz opioidlerin, ketaminin, epidural, kaudal, spinal uygulamaların ve lokal anestetik infiltrasyon yöntemleri-nin preemptif ve ameliyat sonrası uygulamalarının analjezik yönden fark olmadığı sonucuna varmışlar-dır. [8] Aynı araştırmacılar preemptif analjezinin değer-lendirilmesinde sadece zamanlamasının değil, süre ve etkinliğinin de önemli olduğunu belirtmişlerdir. Bizim çalışmamızın aksine preemptif analjezinin ameliyat sonrası ağrı tedavisinde etkili olmadığını gösteren çalışmalar da vardır.…”

The Effect of Single Dose Oral Gabapentin as Preemptive Analgesia for Postoperative Pain for Orthopedic Surgeries Done Under Spinal Anaesthesia

“…This analgesic administration is supposed to decrease surgical stress response as well as postoperative analgesic requirements. 1 Gabapentin is a structural analogue of gamma-amino butyric acid, which was introduced in 1994 as an antiepileptic drug, particularly for partial seizures. Gabapentin has demonstrated its utility in the treatment of chronic neuropathic pain.…”

“…This analgesic administration is supposed to decrease surgical stress response as well as postoperative analgesic requirements. 1 Various drugs like opioids, NSAIDs, antiepileptic drugs are being used for purpose of preemptive analgesia. Opioids act at peripheral, posterior horn of spinal cord as well as CNS level to offer preemptive analgesia.…”