Related Experiment Video
Updated: Aug 7, 2026
14:56
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Pre-emptive analgesia and protective premedication. What is the difference?
1Centre for Anaesthesia, University College London, 4th Floor, Former Nurses Home, 74, Huntley Street, London WC1E 6AU, UK. lesleybromley@compuserve.com
Summary
Pre-emptive analgesia, or giving pain relief before surgery, has mixed evidence. While not a cure-all for postoperative pain, strategies like using gabapentin and pregabalin are being studied.
Area of Science:
- Pain management
- Anesthesiology
- Pharmacology
Background:
- Postoperative pain management is evolving with basic science insights.
- Pre-emptive analgesia, administering pain relief before injury, has shown inconsistent results.
- Methodological challenges hinder comparisons of existing studies.
Purpose of the Study:
- To review the evidence for pre-emptive analgesia in postoperative pain.
- To explore the role of adjuvant drugs like gabapentin and pregabalin in protective analgesia.
- To assess the effectiveness of these strategies in reducing pain and opioid use.
Main Methods:
- Review of existing literature on pre-emptive analgesia.
- Analysis of studies using gabapentin and pregabalin as pre-medicants before surgery.
- Meta-analysis of postoperative morphine consumption and side effect reporting.
Main Results:
- Pre-emptive analgesia with opiates is incorporated into anesthetic practice.
- Evidence for pre-emptive non-steroidal anti-inflammatory drugs is weak; local anesthetic blocks are still studied.
- Meta-analysis shows reduced postoperative morphine use with gabapentin/pregabalin, but minimal impact on side effects.
Conclusions:
- Pre-emptive analgesia is one strategy among many for managing postoperative pain.
- Gabapentin and pregabalin show potential in reducing opioid consumption but are not licensed for postoperative pain.
- Further research, particularly on pregabalin, is needed to optimize postoperative pain management.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:25Analgesia and Pain Management
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
01:24General Anesthesia: Overview
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
01:22Stages of General Anesthesia
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...