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Updated: Mar 25, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children
In-Kyung Song1, Yong-Hee Park2, Ji-Hyun Lee1
1Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul, Korea.
Insights
Preemptive analgesia did not significantly improve postoperative pain control in pediatric patients undergoing corrective osteotomy. While emergence agitation was lower initially, overall pain management and analgesic needs were similar between groups.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Preemptive analgesia aims to prevent central sensitization and manage acute postoperative pain.
- Its effectiveness compared to conventional pain management remains debated.
- This study investigates intravenous preemptive analgesia in pediatric patients.
Purpose of the Study:
- To evaluate the efficacy of preemptive analgesia for acute postoperative pain control in pediatric patients undergoing corrective osteotomy.
- To compare pain scores, emergence agitation, and analgesic requirements between preemptive and conventional analgesia groups.
Main Methods:
- A prospective randomized controlled trial involving 51 children aged 3-7 years.
- Patients received either preemptive (IV-PCA with fentanyl before incision) or conventional (IV-PCA with fentanyl after incision) analgesia.
- Pain scores, emergence agitation, and analgesic consumption were recorded.
Main Results:
- No significant difference in pain scores at 1 hour postoperatively.
- Lower emergence agitation scores on PACU admission in the preemptive group (P=0.002).
- No differences in overall IV-PCA use, pain scores, or complications between groups.
Conclusions:
- Preemptive analgesia with IV-PCA fentanyl did not offer significant advantages for postoperative pain management after corrective osteotomy in children.
- The findings suggest current conventional regimens may be sufficient for this patient population.
Background:
Preemptive analgesia is an anti-nociceptive treatment that starts before surgery and prevents the establishment of central sensitization. Whether preemptive analgesia is more effective than conventional regimens for managing postoperative pain remains controversial. This study evaluated the efficacy of intravenous preemptive analgesia for acute postoperative pain control in pediatric patients.
Methods:
In this prospective randomized controlled trial, 51 children aged 3-7 years, scheduled for corrective osteotomy were randomized into control (group C) or preemptive (group P) group. Both groups received standardized general anesthesia, including intravenous patient-controlled analgesia (IV-PCA) with fentanyl, which was started before skin incision in group P or 5 min thereafter in group C. IV-PCA data, pain scores using verbal rating scale (VRS) and Wong-Baker FACES(®) pain rating scale (WBFS), emergence agitation score (EAS) using the Pediatric Anesthesia Emergence Delirium (PAED) scale, analgesic requirements, and complications were recorded.
Results:
The primary outcome, pain score at postoperative 1 h, showed no difference between the groups. Both groups did not demonstrate emergence agitation (PAED cutoff value ≥ 12), although the EAS at admission to the postanesthetic care unit (PACU) was lower in group P than in group C (P = 0.002; mean difference 4.85, 95% CI 1.97-7.73). There were no differences in the delivered volume of IV-PCA, frequency of pushing the IV-PCA button, effective push attempts, VRS, WBFS, EAS at discharge from the PACU, additional analgesic requirements, and complications.
Conclusion:
Preemptive analgesia using IV-PCA with fentanyl showed no significant advantages for postoperative analgesia after corrective osteotomy in pediatric patients.
