Preemptive Analgesia Clinical Evidence of Neuroplasticity Contributing to Postoperative Pain

Katz, Joel; Kavanagh, Brian P.; Sandler, Alan N.; Nierenberg, H.; Boylan, John F.; Friedlander, Mark; Shaw, Brian F.

doi:10.1097/00000542-199209000-00006

Cited by 438 publications

(138 citation statements)

References 3 publications

(3 reference statements)

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“…[16][17][18][19] Raja et alused epidural anesthesia, which may have reduced postoperative pain by attenuating spinal cord hyperexcitability. [20][21] Sørensen et al showed that additional local anesthesia, intra-articular bupivacaine after intra-articular lidocaine, did not improve postoperative analgesia. 11 We think that the lack of effect of intra-articular ropivacaine in the present study was due to the effects of spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy

Rautoma

Santanen

Avela

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To compare the postoperative analgesic effects of 50 mg diclofenac po before surgery and intra-articular ropivacaine injected after diagnostic day-case knee arthroscopy performed under spinal anesthesia.Methods: In a randomized, double-blind investigation, 200 ASA physical status 1-2 outpatients, age 18-60 yr, received either 50 mg diclofenac po or placebo one hour before operation (100 patients per group), and intraarticular injections of either 20 ml of ropivacaine 0.5% or 20 ml of saline 0.9% (50 patients in each premedication groups). Patients received 50 mg diclofenac po prn and, if needed, 0.1 mg·kg -1 oxycodone im for postoperative pain relief. Patients were discharged home with a supply of 50 mg diclofenac tablets and were given a sheet of paper with knee pain VAS scales and a questionnaire of analgesics taken. Patients rated their VAS scores eight hours after surgery and in the morning and at the end of the first and the second postoperative days, respectively.Results: The only statistically significant difference was found when the diclofenac groups were combined and compared with the combined placebo premedication groups. The VAS scores of knee pain at eight hours after the operation were 19 ± 22 in the two diclofenac premedication groups and 32 ± 28 in the two placebo groups (P=0.001).Conclusions: Diclofenac premedication po reduced the VAS scores at eight hours postoperatively while intraarticular ropivacaine did not.Objectif : Comparer les effets analgésiques postopératoires de 50 mg de diclofénac po, administrés avant l'opération, à la ropivacaïne intra-articulaire, donnée après l'arthroscopie diagnostique sous rachianesthésie.Méthode : Lors d'une étude randomisée et en double aveugle, 200 patients d'état physique ASA I-II, âgés de 18-60 ans, ont reçu 50 mg de diclofénac po ou un placebo une heure avant l'opération (100 patients par groupe), et une injection intra-articulaire de 20 ml de ropivacaïne 0,5 % ou 20 ml de solution salée 0,9 % (50 patients dans chaque groupe de prémédication). Les patients ont reçu 50 mg de diclofénac po prn et, si nécessaire, 0,1 mg·kg -1 d'oxycodone im pour soulager la douleur postopératoire. À leur départ, ils ont reçu des comprimés de 50 mg de diclofénac, un questionnaire concernant la prise d'analgésiques et une feuille de papier où inscrire le niveau de douleur au genou selon l'EVA. Les patients ont estimé leurs scores à l'EVA huit heures après l'opéra-tion et au début et à la fin du premier et du deuxième jours postopératoires, respectivement.Résultats : La seule différence statistique significative a été trouvée en combinant les groupes de diclofénac et en les comparant aux groupes combinés de prémédication placebo. Les scores postopératoires de l'EVA ont été de 19 ± 22 dans les deux groupes qui ont reçu une prémédication de diclofénac et de 32 ± 28 dans les groupes qui ont reçu le placebo (P=0,001). Conclusion :La prémédication au diclofénac po a réduit les scores postopératoires de l'EVA à huit heures, mais non pas la ropivacaïne intra-articulaire.

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Section: Discussionmentioning

confidence: 99%

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy

Rautoma

Santanen

Avela

et al. 2000

Can J Anesth/J Can Anesth

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“…Experimental evidence suggests that noxious stimulation undermines the plasticity of the spinal cord, and impairs sensorimotor recovery following SCI. 35,[59][60][61] Clinically, preemptive analgesia has also been used in an effort to prevent the establishment of central sensitization and postoperative pathological pain, [62][63][64] although the effectiveness of this strategy remains controversial.…”

Section: Figmentioning

confidence: 99%

Nor-Binaltorphimine Blocks the Adverse Effects of Morphine after Spinal Cord Injury

Aceves

Bancroft

Aceves

2017

Journal of Neurotrauma

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Opioids are frequently used for the treatment of pain following spinal cord injury (SCI). Unfortunately, we have shown that morphine administered in the acute phase of SCI results in significant, adverse secondary consequences including compromised locomotor and sensory recovery. Similarly, we showed that selective activation of the j-opioid receptor (KOR), even at a dose 32-fold lower than morphine, is sufficient to attenuate recovery of locomotor function. In the current study, we tested whether activation of the KOR is necessary to produce morphine's adverse effects using norBinaltorphimine (norBNI), a selective KOR antagonist. Rats received a moderate spinal contusion (T12) and 24 h later, baseline locomotor function and nociceptive reactivity were assessed. Rats were then administered norBNI (0, 0.02, 0.08, or 0.32 lmol) followed by morphine (0 or 0.32 lmol). Nociception was reassessed 30 min after drug treatment, and recovery was evaluated for 21 days. The effects of norBNI on morphine-induced attenuation of recovery were dose dependent. At higher doses, norBNI blocked the adverse effects of morphine on locomotor recovery, but analgesia was also significantly decreased. Conversely, at low doses, analgesia was maintained, but the adverse effects on recovery persisted. A moderate dose of norBNI, however, adequately protected against morphine's adverse effects without eliminating its analgesic efficacy. This suggests that activation of the KOR system plays a significant role in the morphineinduced attenuation of recovery. Our research suggests that morphine, and other opioid analgesics, may be contraindicated for the SCI population. Blocking KOR activity may be a viable strategy for improving the safety of clinical opioid use.

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“…The rationale for preemptive analgesia in the management of postoperative pain has been reviewed in detail (Katz et al, 1992;Coderre et al, 1993;Dahl and Kehlet, 1993;Woolf and Chong, 7993;Katz,1995 (Maduska and Hajghassemali, 1978;White et al, 1982;Bourke et aL, 1987;Owen et al, 1981;Peat et al, 1989;Edwards et aI., 1993;Jahangir et al, 1993;Bhattacharya et a1.,1994 Jahangir et al, 1993 ;Bhattacharya et al, 199 4). Two studies (Joachimsson et al, 1986;Roytblat et a1.,1993) found a decrease in heart rate and blood pressure which was attributed to a decrease in pain.…”

Section: Preemptive Ketaminementioning

confidence: 99%

Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

Schmid

Sandler

Katz

1999

Pain

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490

268

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Preemptive Analgesia Clinical Evidence of Neuroplasticity Contributing to Postoperative Pain

Cited by 438 publications

References 3 publications

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy

Diclofenac premedication but not intra-articular ropivacaine alleviates pain following day-case knee arthroscopy

Nor-Binaltorphimine Blocks the Adverse Effects of Morphine after Spinal Cord Injury

Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

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