Abstract
Numerous experimental studies have shown that systemic or regional administration of analgesics prior to a nociceptive stimulus results in a significant reduction of analgesic requirements compared with the administration of the same analgesic dose given after the nociceptive stimulus. This phenomenon is called “preemptive analgesia”. Recently several clinical studies have been conducted to determine whether “preemptive analgesia” also occurs in humans. Regional and systemic opioids, local anesthetics and non-steroidal anti-inflammatory drugs have been investigated so far. Most studies have failed to show a significant reduction in postoperative analgesic requirements with preemptive analgesia. Even in studies with positive results the reduction in analgesic requirements was limited and without clinical relevance. Further studies should focus on the questions which analgesics and which administration routes might provide clinically significant “preemptive analgesia” and how long analgesia should be prolonged into the postoperative period.
Zusammenfassung
Zahlreiche experimentelle Untersuchungen haben belegt, daß die Gabe eines Analgetikums vor einem experimentellen Schmerz zu geringeren Schmerzen führt als die Gabe des gleichen Analgetikums nach dem nozizeptiven Reiz. In einer Reihe von Studien wurde untersucht, ob diese sog. “präemptive Analgesie” auch für die Klinik von Bedeutung ist. Obwohl in einigen Studien für bestimmte Zeitintervalle statistisch ein geringerer postoperativer Analgetikaverbrauch gesichert werden konnte, bleibt angesichts der über-wiegend negativen Ergebnisse die klinische Bedeutung der “präemptiven Analgesie” derzeit offen. Zukünftige Studien müssen zeigen, welche Substanzen unter welchen Applikationsrouten zu einer klinisch relevanten “präemptiven Analgesie” führen.
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Herrn Prof. Dr. ing. Manfred Zimmermann zum 60. Geburtstag gewidmet.
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Tryba, M. Präemptive Analgesie: Klinische Realität oder wissenschaftliche Hypothese?. Schmerz 8, 1–4 (1994). https://doi.org/10.1007/BF02527503
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DOI: https://doi.org/10.1007/BF02527503
Key words
- Postoperative analgesic requirements
- Pain
- Preemptive analgesia
- Systemic administration Regional administration
- Analysis