Abstract
Purpose
This two-part review summarizes the current knowledge of physiological mechanisms, pharmacological modalities and controversial issues surrounding preemptive analgesia.
Source
Articles from 1966 to present were obtained from the MEDLINE databases. Search terms included analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents.
Principal findings
In Part I of this review article, techniques and agents that attenuate or prevent central and peripheral sensitization were reviewed. In Part II, the conditions required for effective preemptive techniques are evaluated. Specifically, preemptive analgesia may be defined as an antinociceptive treatment that prevents establishment of altered central processing of afferent input from sites of injury. The most important conditions for establishment of effective preemptive analgesia are the establishment of an effective level of antinociception before injury, and the continuation of this effective analgesic level well into the post-injury period to prevent central sensitization during the inflammatory phase. Although single-agent therapy may attenuate the central nociceptive processing, multimodal therapy is more effective, and may be associated with fewer side effects compared with the high-dose, single-agent therapy.
Conclusion
The variable patient characteristics and timing of preemptive analgesia in relation to surgical noxious input require individualization of the technique(s) chosen. Multi-modal analgesic techniques appear more effective.
Résumé
Objectif
La présente revue, en deux parties, résume les connaissances actuelles sur les mécanismes physiologiques et les modalités pharmacologiques de l’analgésie préventive ainsi que sur les questions controversées qui l’entourent.
Source
Des articles, de 1966 à aujourd’hui, obtenus à partir des bases de données MEDLINE. Les termes de la recherche comprennent: analgesia, preemptive; neurotransmitters; pain, postoperative; hyperalgesia; sensitization, central nervous system; pathways, nociception; anesthetic techniques; analgesics, agents.
Constatations principales
Dans la Partie I de cet exposé de synthèse, les techniques et les médicaments qui atténuent ou préviennent la sensibilisation centrale et périphérique ont été réexaminés. Dans la Partie II, les conditions nécessaires à l’efficacité des techniques préventives sont évaluées. Plus précisément, on peut définir l’analgésie préventive comme un traitement antinociceptif qui prévient la transmission centrale altérée du stimulus afférent provenant des sites de lésion. Les conditions les plus importantes de son efficacité sont l’établissement d’un niveau suffisant d’antinociception avant la lésion et l’entretien de ce niveau d’analgésie efficace après la lésion afin d’empêcher la sensibilisation centrale pendant la phase inflammatoire. Même si le traitement avec un médicament unique peut diminuer la sensibilisation nociceptive centrale, le traitement multimodal est plus efficace et peut comporter moins d’effets secondaires comparativement à la forte dose d’un médicament unique.
Conclusion
La diversité des patients et le moment choisi pour administrer l’analgésie préventive en relation avec le stimulus chirurgical nocif exigent une individualisation des techniques choisies. Des techniques analgésiques multimodales semblent plus efficaces.
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Kelly, D.J., Ahmad, M. & Brull, S.J. Preemptive analgesia II: recent advances and current trends. Can J Anesth 48, 1091–1101 (2001). https://doi.org/10.1007/BF03020375
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DOI: https://doi.org/10.1007/BF03020375