Abstract
Pain can play an important role at the social and psychological level; hence one of the major goals of anaesthesia is to control and reduce the incidence of postoperative pain. The use of an analgesia before surgical incision may offer one of the most innovative and promising strategies for better pain control throughout the perioperative period. Pre-emptive analgesia refers to pharmacological intervention initiated prior to a painful stimulus in order to inhibit nociceptive mechanisms before they are triggered. Pre-emptive analgesia has three objectives: to reduce pain resulting from the activation of inflammatory mechanisms triggered by surgical incision; to hinder the pain memory response of the central nervous system; and to ensure a good control of postoperative pain in order to avoid the development of chronic pain. The following provides an overview of the scientific rationale for pre-emptive analgesia alongside an overview of published systematic reviews and randomized clinical trials related to this topic.
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References
Kaye AD, Baluch A, Kaye AJ, et al. Pharmacology of cyclo-oxygenase-2 inhibitors and preemptive analgesia in acute pain management. Curr Opin Anaesthesiol 2008 Aug; 21(4): 439–45
Phillips DM. JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA 2000 Jul 26; 284(4): 428–9
American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2004 Jun; 100(6): 1573–81
Campiglia L, Cappellini I, Consales G, et al. Premedication with sublingual morphine sulphate in abdominal surgery. Clin Drug Investig 2009; 29Suppl. 1: 25–30
Wall PD. The prevention of postoperative pain. Pain 1988 Jun; 33(3): 289–90
Grape S, Tramer MR. Do we need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesthesiol 2007 Mar; 21(1): 51–63
Lariviere WR, Melzack R. The role of corticotropin-releasing factor in pain and analgesia. Pain 2000 Jan; 84(1): 1–12
Randic M, Jiang MC, Rusin KI, et al. Interactions between excitatory amino acids and tachykinins and long-term changes of synaptic responses in the rat spinal dorsal horn. Regul Pept 1993 Jul 2; 46(1-2): 418–20
Ahmadi S, Lippross S, Neuhuber WL, et al. PGE(2) selectively blocks inhibitory glycinergic neurotransmission onto rat superficial dorsal horn neurons. Nat Neurosci 2002 Jan; 5(1): 34–40
Moiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002 Mar; 96(3): 725–41
Kress M, Koltzenburg M, Reeh PW, et al. Responsiveness and functional attributes of electrically localized terminals of cutaneous C-fibers in vivo and in vitro. J Neurophysiol 1992 Aug; 68(2): 581–95
Melzack R, Coderre TJ, Katz J, et al. Central neuroplasticity and pathological pain. Ann N Y Acad Sci 2001 Mar; 933: 157–74
Coderre TJ, Melzack R. The contribution of excitatory amino acids to central sensitization and persistent nociception after formalin-induced tissue injury. J Neurosci 1992 Sep; 12(9): 3665–70
Kissin I. Preemptive analgesia: terminology and clinical relevance. Anesth Analg 1994 Oct; 79(4): 809–10
Dahl JB, Moiniche S. Pre-emptive analgesia. Br Med Bull 2004; 71: 13–27
Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000 Oct; 93(4): 1123–33
Macrae WA. Chronic pain after surgery. Br J Anaesth 2001 Jul; 87(1): 88–98
Scholz J, Woolf CJ. Can we conquer pain? Nat Neurosci 2002 Nov; 5 Suppl.: 1062–7
Alhaider AA, Lei SZ, Wilcox GL. Spinal 5-HT3 receptor-mediated antinociception: possible release of GABA. J Neurosci 1991 Jul; 11(7): 1881–8
Woolf CJ, Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity states. Pain 1991 Mar; 44(3): 293–9
Fisher K, Coderre TJ, Hagen NA. Targeting the N-methyl-D-aspartate receptor for chronic pain management. Preclinical animal studies, recent clinical experience and future research directions. J Pain Symptom Manage 2000 Nov; 20(5): 358–73
Davar G, Hama A, Deykin A, et al. MK-801 blocks the development of thermal hyperalgesia in a rat model of experimental painful neuropathy. Brain Res 1991 Jul 12; 553(2): 327–30
Mao J, Price DD, Hayes RL, et al. Differential roles of NMDA and non-NMDA receptor activation in induction and maintenance of thermal hyperalgesia in rats with painful peripheral mononeuropathy. Brain Res 1992 Dec 11; 598(1-2): 271–8
Katz J, McCartney CJ. Current status of preemptive analgesia. Curr Opin Anaesthesiol 2002 Aug; 15(4): 435–41
Kissin I. Preemptive analgesia at the crossroad. Anesth Analg 2005 Mar; 100(3): 754–6
Dahl JB, Mathiesen O, Moiniche S. ’Protective premedication’: an option with gabapentin and related drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain. Acta Anaesthesiol Scand 2004 Oct; 48(9): 1130–6
Kissin I. Preemptive analgesia. Anesthesiology 2000 Oct; 93(4): 1138–43
Crile GW. The kinetic theory of shock and its prevention through anociassociation (shockless operation). Lancet 1913; 185:7–16
McQuay HJ. Pre-emptive analgesia: a systematic review of clinical studies. Ann Med 1995 Apr; 27(2): 249–56
Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia II: recent advances and current trends. Can J Anaesth 2001 Dec; 48(11): 1091–101
McCartney CJ, Sinha A, Katz J. A qualitative systematic review of the role of N-methyl-D-aspartate receptor antagonists in preventive analgesia. Anesth Analg 2004 May; 98(5): 1385–400
Ong CK, Lirk P, Seymour RA, et al. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005 Mar; 100(3): 757–73
Bong CL, Samuel M, Ng JM, et al. Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth 2005 Dec; 19(6): 786–93
Katz J, Cohen L, Schmid R, et al. Postoperative morphine use and hyperalgesia are reduced by preoperative but not intraoperative epidural analgesia: implications for preemptive analgesia and the prevention of central sensitization. Anesthesiology 2003 Jun; 98(6): 1449–60
Katz J, Schmid R, Snijdelaar DG, et al. Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use. Pain 2004 Aug; 110(3): 707–18
Lavand’homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 2005 Oct; 103(4): 813–20
Barczyński M, Konturek A, Herman RM. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 2006 Jul; 20(7): 1088–93
Karaaslan D, Sivaci RG, Akbulut G, et al. Preemptive analgesia in laparoscopic cholecystectomy: a randomized controlled study. Pain Pract 2006 Dec; 6(4): 237–41
Long JB, Eiland RJ, Hentz JG, et al. Randomized trial of preemptive local analgesia in vaginal surgery. Int Urogynecol J Pelvic Floor Dysfunct 2009 Jan; 20(1): 5–10
Acknowledgements
We thank Melanie Gatt of inScience Communications, a Wolters Kluwer business, who provided English-language and editorial assistance in the preparation of this article. This assistance was funded by Molteni Farmaceutici, Inc., Italy. Laura Campiglia, Guglielmo Consales and Angelo Raffaele De Gaudio declare no relevant conflicts of interest relevant to this article.
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Campiglia, L., Consales, G. & De Gaudio, A.R. Pre-Emptive Analgesia for Postoperative Pain Control. Clin. Drug Investig. 30 (Suppl 2), 15–26 (2010). https://doi.org/10.2165/1158411-S0-000000000-00000
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DOI: https://doi.org/10.2165/1158411-S0-000000000-00000