What is the Role of NSAIDs in Pre-emptive Analgesia?

Abstract

NSAIDs inhibit the cyclo-oxygenase enzymes, and decrease peripheral and central prostaglandin production. In addition to reducing the inflammation that accompanies tissue injury, decreasing prostaglandin production attenuates the response of the peripheral and central components of the nervous system to noxious stimuli. Such a reduction in the response to pain can reduce the peripheral and central sensitisation induced by noxious stimuli, and reduce the pain experienced in response to subsequent noxious stimuli. These properties would seem to make NSAIDs ideal drugs to use in a pre-emptive fashion, where analgesics are administered prior to a noxious stimulus, such as surgery, with the expectation that reduction in peripheral and central sensitisation will lead to a decrease of pain.However, the available perioperative trials of pre-emptive NSAID use have yielded modest or equivocal results, and these may be due, in part, to controversy associated with the definition of pre-emptive analgesia and how to conduct the corresponding clinical trials. Although NSAIDs may have a limited ability by themselves to induce a pre-emptive analgesic effect, the available trials suggest how the perioperative use of these drugs may be made more effective. It is expected that NSAIDs will play an increasing role in multimodal analgesia and pain relief in general.

Acute physiological responses to castration-related pain in piglets: the effect of two local anesthetics with or without meloxicam

“…NSAID decrease prostaglandin production and modify cytokine ratios; as a consequence, NSAID attenuate the nervous system response to noxious stimuli (Ochroch et al, 2003). In accordance with these facts, previous research found that piglets receiving meloxicam preoperatively showed significantly lower cortisol levels 30 min to 4 h after castration than controls (Langhoff et al, 2009), but there was no difference in vocalization during castration in meloxicam-treated and untreated piglets (Reiner et al, 2012).…”

“…Outcomes observed at 24 h after castration may not be accurate indicators for NSAID activity (Ochroch et al, 2003;O'Connor et al, 2014). No effect of treatment on growth was detected; other authors described similar results (Carroll et al, 2006), suggesting that growth rates are not a good indicator of acute pain in piglets.…”

Effect of oral meloxicam on health and performance of beef steers relative to bulls castrated on arrival at the feedlot1

“…Nonsteroidal anti-inflammatory drugs produce analgesia and reduce inflammation by inhibiting the enzyme cyclooxygenase and subsequent PG production in the peripheral tissues and central nervous system (Ochroch et al, 2003). Surgery-induced pain consists of 2 phases: an immediate incisional phase and a prolonged inflammatory phase that arises primarily due to tissue damage (Kissin, 2000;Gottschalk and Smith, 2001).…”

The Effects of Preemptive Analgesia of Morphine and Ketorolac on Postoperative Pain, Cortisol, O2 Saturation and Heart Rate

“…대한 기억을 방해하거나 통증 인지를 저하시키는 것으로 정의된 다 (Kaufman, Epstein, Gorsky, Jackson, & Kadari, 2005;Marret et al, 2005;Norman et al, 2001;Ochroch, Mardini, & Gottschalk, 2003). 몇몇 선행 연구에서 선행진통법이 수술 후 진통제 투여량을 감소시키고 부작용을 완화시키는 것으 로 보고하고 있다 (Grass, 2005;Kim & Yoon, 2006;Marret et al, 2005;White, 2005).…”